Required Forms
The following must be submitted before the first day of school every year to your account on the SA Families Site; upon expiration, new up-to-date forms must be submitted.
Health Forms
Physical Form: Physical forms are valid for one year following the date listed on the form. Talk to your child’s physician for more details, and see this sample health form.
Immunization Records: It is critically important that your child’s immunizations are up-to-date. Diseases like measles and whooping cough are highly contagious, but preventable. Based on your child’s age, there are certain immunizations they must receive to attend school. Under New York law, there are no religious exemptions for mandatory immunization requirements. This law applies to all public and private schools, in New York, not just SA, and requires that all scholars be fully immunized. Per State law, if your child’s immunizations are not up-to-date, they cannot attend school.
COVID-19 Vaccination Record: If your scholar is vaccinated for COVID-19, please upload a photo of your scholar’s vaccination card to the SA Families Site. While this is not a requirement, it is a Success Academy expectation and in accordance with public health policy and medical expertise.
Medication Administration Form (MAF): If your child needs to take any prescription or over-the-counter medication, including for asthma or allergies, during the school day, you must bring the properly packaged and labeled medication to school and submit a new MAF each school year.
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 district requirements; these requirements are listed on the SA Families Site. Families in transitional housing or who are experiencing homelessness are not required to provide proof of address, but instead must submit the Residency Questionnaire.
Acceptable proofs of residency: Utility bill (cable, gas, landline phone, electric, water bill), Lease or rent statement, tax documents, paychecks, any letter from a government agency (from the IRS, HRA, Medicaid, City Housing Authority, ACS, Child Health Plus, or for food stamps, etc.)
Unacceptable proofs of residency: Any document missing the resident’s name and address, driver’s license or Social Security card, bank statements, cell phone bills, or letters from banks, employers, private insurance companies, or hospitals
Scholar 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. 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.
IEP and 504 Plan: New families whose scholars have an Individualized Education Program (IEP) or 504 Plan. IEPs and 504 Plans for returning Success Academy scholars are already on file with scholars’ schools.
Other Forms
These forms are completed digitally through your scholar’s SA Families account and valid from K-12, unless otherwise noted.
Display of Scholar Work: We love showcasing scholar work! Read this Family Educational Rights and Privacy Act (FERPA) memo for more information.
Ethnic Identification Form: 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, after registration and enrollment in a school district, a parent or guardian completes the Home Language Questionnaire. The questionnaire is meant to help diagnose a scholar’s linguistic needs prior to their entry in 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.
Visual and Media Release: 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 sounds of you and your family to be used in these and other outlets.
Housing Questionnaire: This form must be submitted by all new scholars who indicate that they are living in temporary housing upon enrollment or during annual registration. Your responses to this questionnaire are strictly confidential and will determine whether you are eligible for certain services and protections.