New Public and Charter School Form

Name of School *
District *
School Type *
Grade Levels (check all that apply) *

Grade Levels (check all that apply) Grades Kindergarten - 5 Grades 6-8 Grades 9-12
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Fax Fax - ### - ### ####
Head of School Name Head of School Name * First Last
Head of School Email *
4-digit DOE School Code *
Must be 4 digits. Currently Entered: 0 digits.
Is this a new school? *

Is this a new school? Yes No
Was this school renamed or did it replace another school with this school code or same address? *

Was this school renamed or did it replace another school with this school code or same address? Yes No
Previous name of the school and provide any applicable information. *
School Website *
This form completed by *
Email address for the person completing this form *
Additional Staff

If you wish to add additional staff, please also include the following info in the field below.
- First and Last name
- Phone Number (extension if necessary)
- Email Address
Additional Staff