Required Forms

The following must be submitted before the first day of school every year to your account on the SA Family Portal; upon expiration, new up-to-date forms must be submitted.

Health Forms

Health Form (Physical): Families are required to provide a current Health Form, otherwise known as a Physical, annually. Physical forms are valid for one year following the date listed on the form. Families are expected to provide an updated physical form on a rolling basis throughout the school year, at the prior form’s expiration.
Immunization Records: Based on a child’s age, there are certain immunizations they must receive to attend school. Under New York law, there are no exemptions for mandatory immunization requirements for religious or personal reasons. This law applies to all public and private schools in New York and requires that all scholars be fully immunized. Per state law, if a child’s immunizations are not up to date, they cannot attend school. Families are expected to provide updated immunization forms, as needed, throughout the school year.
Medication Administration Form (MAF): If a child needs to take any prescription or over-the-counter medication during the school day, parents must bring the properly packaged and labeled medication to school and submit an MAF dated for the current school year. The MAF must be completed by a doctor (including their license number or stamp) and signed by a parent or guardian. The MAF must also indicate the scholar’s skill level (adult-supervised, nurse-dependent, or independent). If a scholar requires a new MAF during the school year, the family must provide the medication and MAF to the school immediately.

Scholar Information Forms

New York State Proof of Residency: The law requires that all scholars must live in New York State and provide proof to attend any Success Academy school. Scholars living outside of New York City must provide additional proof of residency depending on their district requirements; these requirements are listed on the SA Family Portal. All families must complete a Residency Questionnaire regardless of where they live and may be prompted to submit a proof of address. Families in transitional housing or who are experiencing homelessness are not required to provide proof of address.

Proof of Identity: Success Academy requires you to verify your scholar’s identity and date of birth, the most common of which is the birth certificate. If you are unable to provide a birth certificate, please upload an alternative proof of date of birth. If necessary, the Main Office will reach out to you to discuss alternative options.
IEP and/or 504 Plan: We ask that families whose scholars have an IEP and/or 504 Plan to indicate so during the Registration process in the Family Portal. Families also have the option to upload their IEP/504 Plan if they have it. IEPs and 504 Plans for returning Success Academy scholars are already on file with scholars’ schools for families that reside within NYC. If families reside outside of NYC but within NYS, they should submit IEPs from their home school district so SA has access.
Court Documentation (if applicable): We also ask that you submit any court orders relating to the custody and/or safety of your scholar to your school’s Main Office. It is critical that you provide our staff with these anytime a court order is updated.

Other Forms

These forms are completed digitally through your Family Portal.

Parent Contract: As mentioned earlier in this handbook, we value your partnership in your child’s success and ask that families review and commit to our expectations.
Student Health Survey: All families are required to complete a form to indicate if their scholar has medical conditions, food restrictions, and/or requires medication at school.
Contact List:
1. - Priority Contacts: Families must provide up-to-date contact information for individuals who should receive school communications and confirm they have educational decision rights. Families can add a maximum of two and minimum of one priority contact.
  - Emergency Contacts/Pickup List: Families must provide names and contact information for the individuals who should be contacted in the event of an emergency and indicate which of these individuals can pick up. Families can add a maximum of 10 Emergency/Pickup list contacts.
Directory Information: Read this Family Educational Rights and Privacy Act (FERPA) memo for more information.
Ethnic Identification: The U.S. Department of Education collects and records the ethnic identity of public school students. This information is used only for statistical analysis, data reporting, and accountability determinations. Children may not be refused admission to a public school because of race, color, creed, national origin, gender, gender identity, pregnancy, immigration or citizenship status, disability, sexual orientation, religion, or ethnicity.
Home Language Questionnaire: As mandated by the New York State Education Department, a parent or guardian must complete the Home Language Questionnaire. The questionnaire is meant to help diagnose a scholar’s linguistic needs prior to their entry into school.
Field Studies Consent Form: Our scholars will participate in numerous field studies and activities throughout the school year. These are invaluable learning experiences, and you are asked to sign one form agreeing to your child’s participation in all off-campus activities, including field studies.
Media Consent & Showcasing your scholar’s work: Sharing the joy and magic with our class or school community — or even sometimes more broadly — is what we do at SA. By signing this form, you are giving permission for images and multiple forms of media involving you and your family to be used in these and other outlets.
Free and Reduced Price Lunch Eligibility: All families must provide household financial information annually to help determine eligibility for free or reduced price lunch. All families in NYC now receive free lunch; however, this information will inform other financial reporting. This information is confidential.
Housing Questionnaire: Families must confirm if the address we have on file is accurate and if they live in permanent or temporary housing. Your responses to this questionnaire are strictly confidential and will determine whether you are eligible for certain services and protections.

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