New Beginnings Family Academy

184 Garden Street, Bridgeport, CT 06605 - Phone: 203-384-2897 Fax: 203-384-2898
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	2010-2011 APPLICATION FORM APPLICATIONS WILL BE ACCEPTED ONLY BETWEEN MARCH 1 AND APRIL 9, 2010 At New Beginnings Family Academy, intelligence plus character is our ultimate goal. We prepare our students for outstanding academic success in high school, college and beyond by building intelligence plus character. Please complete the form below. Mandatory fields marked * Student Information Your child's present grade:* Will your child reenroll in NBFA for the 2010/2011academic year?* Child's First Name:* Child's Middle Name:* Child's Last Name:* Date of Birth (mm/dd/yyyy):* Gender:* Has your child ever received any special education services?* IF so, how many hours of service is your child receiving? Please check all areas in which your child has received services: Preschool Birth to Three Speech and Language Social Worker Occupational or Physical Therapy Does your child have siblings (brothers or sisters living in the same home) at NBFA?:* Please state sibling name(s): Race/Ethnicity:Black Hispanic White American Indian Asian American Primary Language Spoken at Home: English Spanish Other: Parent Information Parent/Guardian Name:* Home Mailing Address:* City:* State:* Zip Code:* Home Phone:* Work Phone: Cell Phone:* Email: Emergency Contact Name:* Signature I understand that New Beginnings Family Academy has high expectations for all of its members – educators, students and parents. I understand and agree that parental participation and cooperation are required and look forward to playing an active role in my child’s learning process at home and school. I understand that space is limited in each grade and that siblings of current students are given preference. I understand and agree that if my child is reenrolled, I must attend a mandatory orientation session in order to secure his/her seat and that failure to do so will result in a forfeiture of the seat. I understand and agree that an original birth certificate, Social Security card, physical exam within the calendar year and up-to-date immunization records must be provided to New Beginnings Family Academy before my child can be reenrolled and that failure to provide these documents will also result in forfeiture of the seat. Parent/Guardian SignatureDate:
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