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BUFFALO PUBLIC SCHOOLS ELEMENTARY SCHOOL APPLICATION 2022-2023

Student Placement & Registration ▪ 33 Ash Street ▪ Buffalo, NY 14204 ▪ (716) 816-3717 Telephone

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* 1. Applying for grade?

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* 2. Current School

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* 3. Student Name

Last

First

Middle Initial

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* 4. Date of Birth

Please enter DOB in MM/DD/YYYY format

Date

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* 5. Gender

Female

Male

Non-Binary

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* 6. Student ID (Not SSN)

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* 7. Twin

Yes

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* 8. Is the student Hispanic, Latino, or of Spanish origin?

Yes

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* 9. Race

American Indian or Native Alaskan

Asian

Black

Native Hawaiian or other Pacific Islander

White

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* 10. Student Address

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* 11. Apt Number

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* 12. City/Town

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* 13. State

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* 14. Zipcode

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* 15. Parent/Caregiver Info

Last Name

First Name

Cell Phone Number

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* 16. Parent/Caregiver Home Phone

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* 17. Parent/Caregiver Email

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* 18. Does the student receive 504/ADA (American Disability Act) services?

Yes

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* 19. Does the student currently receive special education services?

Yes

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* 20. If so, what level service?

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* 21. Does the student speak or understand a language other than English?

Yes

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* 22. If so, what other language is spoken in the home?

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* 23. Has this student ever received ENL (formerly ESL) or bilingual services?

Yes

SCHOOL CHOICES: All School Assignments will carry a one-year commitment, NO EXCEPTIONS.

Please carefully select school number(s) and program code(s) for each school choice. Choices are to be listed in order of preference from 1 to 5. Each selection is one choice (2 programs for the same school count as 2 choices).

Families are not required to select all 5 choices. Please only select the schools you are interested in your child attending.

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* 24. Choice 1

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* 25. Choice 2

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* 26. Choice 3

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* 27. Choice 4

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* 28. Choice 5

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* 29. If applying to Buffalo Academy of Visual and Performing Arts, attach your Recommendation Forms

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 30. If applying to Buffalo Academy of Visual and Performing Arts, attach Teacher Evaluation Form

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

SIBLING PREFERENCE: To receive sibling preference, list the name of one sibling attending one of your school choices above

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* 31. Sibling 1 Name

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* 32. Sibling 1 Current School

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* 33. Sibling 2 Name

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* 34. Sibling 2 Current School

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* 35. Sibling 3 Name

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* 36. Sibling 3 Current School

CO-APPLICANTS: If you are also submitting an application for another sibling (living in the same household) and would like him/her to be assigned together to the same school, fill in the name below. You MUST complete a separate application for each student.

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* 37. Co-Applicant 1 Name

Last

First

Middle Initial

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* 38. Co-Applicant School

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* 39. Co-Applicant 2 Name

Last

First

Middle Initial

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* 40. Co-Applicant 2 School

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* 41. Co-Applicant 3 Name

Last

First

Middle Initial

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* 42. Co-Applicant 3 School

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* 43. I acknowledge that I am the parent or legal guardian for the applicant.

Yes

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* 44. I acknowledge all school assignments will carry a one-year commitment.

Yes

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* 45. I certify that my primary residence will be within the city limits of Buffalo, NY by July 1, 2022.

Yes