SPLASH! Spanish Language Immersion Program 2022-2023 First Grade Application
Bethany Elementary, and Stoneville Elementary Schools are accepting applications for first grade students for their Spanish Language Immersion Programs. Students will be placed in the program in the order in which the applications are received until the class is full. If a student is not selected, he/she will be placed on the waiting list. If applying for more than one child, please complete a separate application for each child.  
PLEASE COMPLETE ALL INFORMATION BELOW
Email *
Student Name *
Gender *
Race *
Date of Birth *
MM
/
DD
/
YYYY
Parent / Guardian Name(s) *
Address (Street, City, State, Zip Code) *
Home Phone *
Cell Phone *
Work phone
What is the primary language spoken at home? *
Attendance Zone School Assignment:
1st Choice *
2nd Choice *
3rd Choice
Are you an employee of Rockingham County Schools? *
Does the applicant have a sibling in the SPASH! Program? *
How did you hear about the immersion program?
Name of Individual Completing This Form *
*If you have any questions, please contact Nancy Towler*
Phone: 336-627-2600
Email: ntowler@rock.k12.nc.us
A copy of your responses will be emailed to the address you provided.
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