New Haven Promise Parent Pledge

Your Information

First Name

Last Name

Phone Number

Your Children

Relationship

Child 1

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Male Female

Current School

Anticipated HS Graduation

Student ID Number (optional) Student ID is the 5 or 6 digit number on the School ID Card and is used for lunch.

Child 2

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Male Female

Current School

Anticipated HS Graduation

Student ID Number (optional)

Child 3

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Male Female

Current School

Anticipated HS Graduation

Student ID Number (optional)

Child 4

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Male Female

Current School

Anticipated HS Graduation

Student ID Number (optional)

Parent/Guardian Signature & Agreement

My signature below indicates that I have read and understand the terms of the New Haven Promise Scholarship. It also authorizes the School District of New Haven or approved public charter schools in the City of New Haven to release information from my child’s education records to New Haven Promise for the purpose of determining scholarship eligibility.

Signature

Date (mm/dd/yyyy)

Parent Pledge Form