NBFA Lottery Application 2024-2025 (Bridgeport Residents Only)

Child's First Name*

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Child's Middle Name*

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Child's Last Name*

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Child's Date of Birth*

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Child's Gender*

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Male

Female

Non-binary (students who do not identify exclusively as male or female)

What grade will your child enter?*

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Pre-K3 (Child must turn 3 on or before September 1 and should be fully potty-trained)

Pre-K4

Kindergarten (Child must turn 5 on or before September 1)

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Does your child have any siblings already at NBFA?*

Answer Required

Yes

If yes please print the name and grade of each sibling below.

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Please check the following box to Release the Following information on my Son/Daughter*

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I HEREBY AUTHORIZE MY CHILD'S FORMER SCHOOL TO RELEASE RECORDS NEEDED

· Academic / Cumulative record folder with state SASID number

· Medical Records

· Confidential Records (SPED information, IEP, Evaluation and any specialized information)

· Attendance and Discipline

Please check all areas in which your child has received services:

Answer Required

Pre-School

Birth-to-three

Speech and language

Social Worker

Occupational or Physical Therapy

None

Contact Information

Parent/Legal Guardian First Name (1)*

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Parent/Legal Guardian Middle Name (1)

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Parent/Legal Guardian Last Name (1)*

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Email 1*

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Mobile Phone*

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Home Phone

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Work Phone*

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Street Address*

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City*

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Zip/Postal*

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Parent/Legal Guardian First Name (2)

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Parent/Legal Guardian Middle Name (2)

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Parent/Legal Guardian Last Name (2)

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Mobile Phone

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Home Phone

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Work Phone

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Street Address

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City

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Zip/Postal

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My Student's Address

Students Address of Residence. Street, State, City and Zip Code*

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What else should we know about your child?

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How did you hear about our school, New Beginnings Family Academy (NBFA)?*

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Word of mouth

Social media

Community advertisement

Lawn sign

Referral

Other:

Who referred you to NBFA?*

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NBFA accepts applications from residents of the city of Bridgeport ONLY.

NBFA accepts new applicants and the blood siblings or those with shared legal guardianship and living in the same home of existing NBFA students. NBFA does not discriminate on the basis of race, color, national origin, disability, sex, gender identity or religion. By signing below, you understand and agree to (a) play an active role in your child’s/ren’s learning at home and school including, but not limited to, regularly attending school events and working collaboratively with administration and teachers; (b) that a seat at NBFA is not guaranteed until an enrollment acceptance meeting is held with staff; and (c) that failure to comply with any of the above will result in forfeiture of the seat. I have read the above and, by signing below, I acknowledge that I agree to the terms outlined by New Beginnings Family Academy.

Today's Date

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Header Motto

Please fix the highlighted areas below before submitting.

NBFA Lottery Application 2024-2025 (Bridgeport Residents Only)