2021-2022 SVCS Application
To apply to the Surry Village Charter School, please complete this form and submit.
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Email *
Child's First Name *
Child's Middle Name *
Child's Last Name *
Complete Mailing Address *
Street, City, State, Zip Code
Birthdate *
MM
/
DD
/
YYYY
Town and State of Birth *
Country of Birth *
Date 1st entered US Schools (If Country of Birth not US)
Gender *
Current School
Current Grade *
Grade Entering 2021-2022 *
If Kindergarten
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Parent 1 Name *
Parent 1 Email Address *
Parent 1 Full Address (if different from above)
Street, City, State, Zip Code
Parent 1 Home Phone
Parent 1 Cell Phone
Parent 2 Name
Parent 2 Email Address
Parent 2 Address (if different from above)
Street, City, State, Zip Code
Parent 2 Home Phone (if different from above)
Parent 2 Cell Phone
Child Lives With: *
Special Custodial Court Instructions: If yes, please provide a copy of court order.
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Please list all siblings applying
Is the child the sibling of a current student?
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Statement of Interest *
Please briefly describe your interest in Surry Village Charter School
How did you find out about SVCS?
By submitting this form, I agree that the above information is correct, I understand that this application does not guarantee a position for my child at the Surry Village Charter School. I attest that I am the legal guardian for this child and if my child is able to attend SVCS, I will participate in the SVCS plan for academic expectations and parent involvement. I agree to allow SVCS to receive my child’s student records from the sending school district if he/she is enrolled. *
New Hampshire’s Statutes and Rules require that a school district keep accurate records and updated personal files for all pupils. This information will become part of the student's permanent cumulative record and will be available to appropriate staff members and child’s parents. New Hampshire law requires that you provide Immunization information to your child's school.  SVCS does not discriminate admissions based on the information provided.
Thank you for your interest in Surry Village Charter School.
A copy of your responses will be emailed to the address you provided.
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