PASSAIC-ASCS MIDDLE SCHOOL
Online Student Application Form
   
 
  DEAR PARENTS AND APPLICANTS:
  Thank you for your interest in Passaic-ASCS. Application for 2015-2016 is now open. Please note that primary acceptance will be given to Passaic students. The deadline to apply is April 17, 2015 and the lottery date is April 25, 2015. If you have already applied for the 2014-2015 academic year, you need to reapply. Please also note that, if you are interested in applying to our networking schools, a separate application must be submitted for each individual school. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application. Thank you!
   
   Applicant's Personal Information
   
      Year Applying: *
  Grade Applying: *
  Last Name: *
  First Name: *
Middle Name:
  Suffix:
  Date of Birth: *
  Gender: *
 
   Applicant's School Information
   
  Current School: *
  School District: *
  School Address:
  School Phone:   XXX-XXXXXXX
  School Fax:   XXX-XXXXXXX
  Years Attended From:   *
 
   Applicant's Family Information
   
  Applicant lives with: * If Other  
         
  Primary Parent: * If Other: *
  Title:    
  First Name: * Last Name: *
  Street: *
  City: * State: *      Zip: *
  Home Phone: * Work Phone:
  Cell Phone: Email:
         
  Secondary Parent: If Other :
  Title:    
  First Name: Last Name:
  Street:
  City: State:      Zip: 
  Home Phone: Work Phone:
  Cell Phone: Email:
         
         
   How did you hear about Passaic-ASCS Middle School ?
   
   
       
           
  Please briefly state why you wish to have your child enrolled at Passaic-ASCS Middle School.  
   
 
I/We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.