Please fill in the following information. Fields marked with an asterisk (*) are required.

	Part I
	*First Name:
	*Last Name:
	*Mailing Address:
	*City:
	*State:		NY
	*Zip:
	*Phone:
	Work Phone:  (Very Important)
	Other Phone:  (Very Important)
	Email:
Part II
In the area below, please list all of the students for whom you are applying who WILL be in Kindergarten through 6th grade in the Fall of 2010. Note: Please mark Kindergarten students as being in grade 0. Students will not be counted unless both first and last names are included.
	First Name:	Last Name:	Grade in Fall 2010	Currently in Public or Private school?
*1.			0 1 2 3 4 5 6	Public Private
2.			0 1 2 3 4 5 6	Public Private
3.			0 1 2 3 4 5 6	Public Private
4.			0 1 2 3 4 5 6	Public Private
5.			0 1 2 3 4 5 6	Public Private
6.			0 1 2 3 4 5 6	Public Private
7.			0 1 2 3 4 5 6	Public Private
8.			0 1 2 3 4 5 6	Public Private
Problems with the form? Make sure fields that should be blank do not have any spaces or characters in them. If you continue to have problems, let us know.