2013-2014 Application

To apply to the Surry Village Charter School please complete this application and submit.
Gender *
Grade Entering *
If Kindergarten
Is this child currently receiving special education services? *
Is this child currently on a 504? *
Is this child the sibling of a current student? *
How did you find out about the school? *

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.


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.

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Surry Campus
449 Route 12A
Surry, NH 03431

Keene Campus
217 Court Street
Keene, NH 03431