עברית Español Русский Yкраїнська 中国人 Kreyòl ayisyen Leave this field blank Parent/Guardian First Name * Parent/Guardian Last Name * Relationship to student * Mother Father Step-mother Step-father Sibling Aunt Uncle Cousin Grandparent Caretaker Foster parent Other Parent/Guardian Home Address * Parent/Guardian Apartment, Unit, Suite Number (optional) Parent/Guardian City * Parent/Guardian State * Parent/Guardian Zip Code * Contact Preference * Email and text message Email only Text message only Parent/Guardian Email * Parent/Guardian Phone Number * Student First Name * Student Middle Name (optional) Student Last Name * Student Date Of Birth * Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Student Gender * Female Male Student Address * Same as parent/guardian Different from parent/guardian Student Home Address * Student Apartment, Unit, Suite Number * Student City * Student State * Student Zip Code * Current School * Current Grade * Pre-K K 1 2 3 4 5 6 7 8 N/A For which school year are you applying? * Next school year (2024-2025) This school year (2023-2024) Choose the school(s) to which you would like to apply * Hebrew Language Academy - 2186 Mill Avenue, Brooklyn, NY 11234 (Pre-K - 8) Hebrew Language Academy 2 - 1870 Stillwell Avenue, Brooklyn NY 11223 (Pre-K - 5) Staten Island Hebrew Public - 829 Father Capodanno Boulevard, Staten Island, NY 10305 (K-3) Grade applying to * Pre-K(For children born in 2020) K (For children born in 2019) 1 2 3 4 5 6 7 8 Grade applying to (Staten Island) * K (For children born in 2019) 1 2 3 Is there a sibling applying as well? * Please fill out a separate application for each child. Yes No Sibling full name * Sibling birth date * Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 What grade is sibling applying to * Pre K K 1 2 3 4 5 6 7 8 Does this student have a sibling who is currently attending a Hebrew Public school? * Yes No Sibling full name * Sibling birth date * Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Sibling current grade * Choose K 1 2 3 4 5 6 7 8 How did you hear about us? * Postcard in the mail Friends or family referral DOE catalog booklet Facebook or Instagram Ad Website banner advertisement My local Pre-K had your information My local Community Based Organization Ex. JCC/JCH/YMCA/ETC. Print Ad (Ex. Which newspaper or magazine?) Community Event School Fair/Open House Event We're already a Hebrew Public family General online school search Staff referral I live in the neighborhood Schola Pandora YouTube Other Please specify who: * Which Pre-K? * Which CBO? * Which newspaper or magazine? * Which Community Event? * Which School Fair or Open House? * Which staff member? * Please explain how you heard about us * Does your family speak a language other than English at home? * HLA and HLA2 provide children who are not proficient English speakers with priority in the admissions lottery. If you believe your child qualifies for this type of lottery priority, please indicate above. A child qualifies as an English Language Learner (ELL) if English is not his/her native language, and s/he is not yet able to communicate fluently or learn effectively in English. Yes No I prefer to not to answer I have read and agreed to the following: * It is your responsibility to follow up with the school to ensure the receipt of your application by phone or email. Non-Discriminatory Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, gender, national origin, religion or ancestry. A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an application for admission to that school. Applications received after 4/1/2023 will be added to the waitlist. Yes Send