New Mission Application for Admission

Name *

First Name

Last Name

Student Cell *

(###)

###

####

Gender

Male

Female

Other

Date of Birth *

MM

DD

YYYY

BPS or NON BPS Charter School? *

BPS School

Non-BPS School (e.g. Charters, Parochial, Private, out-of-state)

**Important Notice for families that are new to the City of Boston, Charter and Private Schools** *

*You must register with Boston Public Schools at a District Welcome Center* Visit bostonpublicschools.org/register for more information and the list of required documents and any BPS Welcome Center locations.

I understand

Guardian Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Contact

(###)

###

####

Guardian 2 (If Applicable)

First Name

Last Name

Address (If different than first guardian)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Phone Contact *

(###)

###

####

I consent to the New Mission Memorandum of Agreement Above *

Yes

No