Student Enrollment Form : College Achieve Paterson

College Achieve Paterson Charter School
Registration Form 2021-2022 / Forma de Matriculación 2021-2022

Please complete the form below. Required fields are marked *
Por favor complete la forma siguiente.  Campos marcados son obligatorios *

Student's First Name / Nombre del Estudiante - Please enter the name as it is stated on their Birth Certificate / Por favor ingrese el nombre como se indica en su Certificado de Nacimiento *

Student's Middle Initial

Student's Last Name / Apellido del Estudiante - Please enter the name as it is stated on their Birth Certificate / Por favor ingrese el nombre como se indica en su Certificado de Nacimiento *

Street Address *

City *

State *

Zip Code / Postal Code *

Sex / Sexo *

Birth Date (must be 10/1/2016 or earlier) / Fecha de Nacimiento (debe ser 10/1/2016 o anterior) *

City of Birth / Ciudad de Nacimiento *

State of Birth *

If other, please list the state in which your scholar was born.

Country of Birth * Country of Birth

Parent/Guardian - First Name (Padre / Tutor - Nombre) *

Parent/Guardian - Last Name (Padre / Tutor - Apellido) *

Relation to Student * Relation to Student

2nd Parent/Guardian - First Name (Padre / Tutor - Nombre)

2nd Parent/Guardian - Last Name (Padre / Tutor - Apellido)

Realtion to Student Realtion to Student

Home Phone / Tel - Casa *

Cell Phone / Tel - Celular *

Work Phone / Tel - Trabajo

Email 1 *

Email 2

Grade as of Sept. 2021 / Grado escolar para Sept. 2021 *

Current Grade *

Current School (Name) / Escuela Que Asiste Actualmente (nombre) *

Current School (City, State) / Escuela Que Asiste Actualmente (Ciudad, Estado) *

Assigned District Public School / Distrito de Escuela Actual *

Do you currently have a child attending College Achieve Paterson Charter School. *

Yes

No

If yes, what is your child's first name.

If yes, what is your child's last name.

If yes, what grade is your child in?

Is your student of Hispanic/Latino orgin? *

Yes

No

I choose not to provide the above data for my student. I understand that College Achieve Paterson Charter School and the State of New Jersey are required to provide this information to the federal government. I understand that College Achieve Paterson Charter School will be required to select race and ethnicity categories on my behalf.

Race *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

I choose not to provide the above data for my student. I understand that College Achieve Paterson Charter School and the State of New Jersey are required to provide this information to the federal government. I understand that College Achieve Paterson Charter School will be required to select race and ethnicity categories on my behalf.

Do you have health insurance? *

Yes

No

Is your child’s native tongue a language other than English? *

Yes

No

If yes, what is the language?

Is the primary language used in your child’s home a language other than English? *

Yes

No

If yes, what is the language?

First Name *

Last Name *

Email 1 *

Email 2

Mobile Phone *

Home Phone *

Work Phone

Electronic Signature
The electronic signature below, and all of its related fields, replace a handwritten signature on paper and is legally binding.

I verify the above information to be correct, and I understand that completion of this form does not guarantee placement in a school. I further understand that I cannot register my child without appropriate address documentation and that only one application can be submitted per child.

I further understand that it is my responsibility as the Parent/Legal Guardian to immediately inform the school of any changes to the information provided.

La firma electrónica abajo y todos sus campos relacionados, reemplaza una firma manuscrita en papel y es legalmente válida.

Verifico que la información anterior es correcta y entiendo que la terminación de este formulario no garantiza la colocación en una escuela. Además, entiendo que no puedo inscribir a mi hijo sin la documentación de la dirección apropiada y que sólo se puede enviar una solicitud por niño.

Además, entiendo que es mi responsabilidad como el Padre / Tutor Legal informar inmediatamente a la escuela de cualquier cambio en la información proporcionada.

I agree / Estoy de acuerdo *

I Agree

Electronic Signature / Firma Electrónica *

Date *

Please have the following information prepared for registration if your child is accepted:

2 proofs of residency (must be current, within 30 days): PSE&G bill, cable bill, car registration or insurance card, employee paystub, or dated letter from the Board of Social Services 
One secondary document: house deed, bank statement, phone bill, credit card bill, notarized lease agreement from the landlord
Photo ID (Drivers License, State ID, Consulate ID)
Student's immunization record
Student's original birth certificate
Transfer Card
Transcripts and/or last report card (1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th)


 Por favor tenga la siguiente información disponible para el registro, si su hijo es aceptado:

Prueba de dirección (debe ser actual, dentro de 30 días): factura de PSE&G, factura de cable, licencia de conducir, identificación estatal o registro de autos, recibo de sueldo del empleado, ID de Consulado, carta fechada de la Junta de Servicio Social
Un documento secundario: escritura de casa, extracto de cuenta bancario, factura de teléfono, cuenta de tarjeta de crédito, contrato de arrendamiento notarizado por el propietario
·         Registro de vacunas del estudiante

·         Certificado de nacimiento original

·         Transferencia + transcripciones o último reporte de calificaiones (1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th)