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Application For Grades 6 - 12
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South Brooklyn Academy
418 East 45th Street
Brooklyn, NY 11203
         Phone:: 718-693-5502  Fax: 718-940-4168

 
 

 

Grade Being Applied For:*  
First Name:
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Middle Name:
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Last Name:
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Birth Date (MM/DD/YY):
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Height:
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Weight:
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Sex:
 Male   Female  *
Birth Place:
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Country of Citizenship:
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Home Address 1:
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Home Address 2:
   
City:
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State:
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Zip:
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Country:
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Home Phone:
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Cell Phone:
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Work Phone:
Church Affiliation: SDA:
 Yes   No  *
Name of Church:
 
Baptized Member:
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Name of Conference:
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Last School Attended:
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Address:
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Telephone Number:
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Last Grade:
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Academic Status:  Were you told to attend Summer School? * If your answer is yes, please answer the next question.  Do you have a copy of your Summer School Report?
Were you ever suspended from your last school: *  
Have you used any of the following recently?    
Tobacco: * Liquor:* Illegal Drugs:*
     
If you answered yes to any, please tell us how recently and explain:
Are you allergic to any food or medication? *
Please List:
The teacher who influenced me the most taught me to: *
Do you desire to live a Christian life? *
Student Commitment: I am willing to obey the rules and regulations stipulated by this institution. Date:
*
The remaining Application Package can be picked up at the School and completed with Social Security Number soon after submitting this Form. You can also click on the Application Package and print the additional Forms to be filled out.

 

Fields marked with an * are required.