2. Student Last Name:
3. Date of Birth: Enter in this format MM/DD/YYYY or 01/24/1995
4. Gender: –Choose–MaleFemale
5. Preferred Gender Pronouns:
6. Student Email: You may also enter a parent’s e-mail address if you cannot create one at this time.
7. Confirm Email: Students should NOT list nycstudent.net emails. You may also enter a parent’s e-mail address if you cannot create one at this time.
8. Home Phone: Please provide a valid number. We may need to speak with you about your application.
9. Student Cell Phone: Please provide a valid number. We may need to speak with you about your application.
10. Home/Mailing Address: Include your apartment number with your street adress. For example: 3614 35th Street Apt 1A. (Do not include city, state, or zipcode here)
11. City: Choose or write the city in your home mailing address. –Choose–ARVERNEASTORIAATLANTIC BEACHBAYSIDEBELLEROSEBREEZY POINTBRONXBRONXVILLEBROOKLYNCAMBRIA HEIGHTSCEDARHURSTCOLLEGE POINTCORONAEAST ELMHURSTEAST ROCKAWAYEASTCHESTERELMHURSTELMONTFAR ROCKAWAYFLORAL PARKFLUSHINGFOREST HILLSFRANKLIN SQUAREFRESH MEADOWSGLEN OAKSGREAT NECKHARRISONHASTINGS ON HUDSONHEWLETTHOLLISHOWARD BEACHINWOODJACKSON HEIGHTSJAMAICAKEW GARDENSLARCHMONTLAURELTONLAWRENCELITTLE NECKLONG ISLAND CITYLYNBROOKMALVERNEMAMARONECKMANHASSETMASPETHMIDDLE VILLAGEMOUNT VERNONNEW HYDE PARKNEW ROCHELLENEW YORKOAKLAND GARDENSOZONE PARKPELHAMPORT WASHINGTONQUEENS VILLAGEREGO PARKRICHMOND HILLRIDGEWOODROCKAWAY PARKROSEDALERYESAINT ALBANSSCARSDALESOUTH OZONE PARKSOUTH RICHMOND HILLSPRINGFIELD GARDENSSTATEN ISLANDSUNNYSIDETUCKAHOEVALLEY STREAMWHITESTONEWOODHAVENWOODMEREWOODSIDEYONKERSOther (please write below)
Only if your city is not listed above, choose “ Other” and write it here:
12. Zip Code:
13. Borough you live in: –Choose–ManhattanQueensBrooklynBronxStaten IslandOther
14. Middle School Name: –Choose––Other–Academy of Applied Mathematics and TechnologyAcademy of Arts and LettersAchievement First Crown Heights Middle SchoolAchievement First Endeavor Charter SchoolAchievement First Endeavor Middle SchoolAlbert Shanker School for Visual and Performing Arts IS126QAll City Leadership Secondary SchoolAnne M DornerBaccalaureate School for Global EducationBaldwin Middle SchoolBronx Green Middle SchoolBronx School for Law, Government and JusticeBrooklyn Ascend Middle SchoolBrooklyn Environmental Exploration School (BEES)Brooklyn Prospect Charter SchoolCarroll Gardens School for Innovation (M.S. 442)Central Queens AcademyColumbia Secondary SchoolCommack Middle SchoolDemocracy Prep Charter Middle SchoolDenzel Washington School of the ArtsDr. Richard Izquierdo Health & Science Charter SchoolEast New York Family AcademyEast New York Middle School of ExcellenceEast Side Community SchoolEast-West School of International StudiesElmont Memorial Junior High SchoolEmolior AcademyEquality Charter SchoolExplore Charter SchoolForte Preparatory AcademyFrederick Douglass AcademyFuture Leaders Institute Charter SchoolGeorge Jackson AcademyGlenwood AcademyGrand Concourse Academy Charter SchoolGrowing Up Green Middle SchoolGrowing Up Green Neighborhood Charter SchoolH. Frank Carey High SchoolHamilton Grange Middle SchoolHudson River Middle School (I.S. 289)Hunter College High SchoolHunter’s Point Community Middle SchoolI. S. 381I.S. 059 Springfield GardensI.S. 093 RidgewoodI.S. 125 Thom J. McCann WoodsideI.S. 141 – The SteinwayI.S. 204 Oliver W. HolmesI.S. 228 David A. BoodyI.S. 230I.S. 235 Lenox AcademyI.S. 285 Meyer LevinI.S. 303 Herbert S. EisenbergI.S. 313 School of Leadership DevelopmentI.S. 318 The School of Mathematics, Science & Technology through the ArtsI.S. 392I.S. 584I.S.?73 ? The Frank Sansivieri Intermediate SchoolIcahn Charter School 4Icahn Charter School 6Immaculate Conception SchoolInternational School for Liberal ArtsInternational School of BrooklynIrwin Altman Middle School 172IS 49 The Dorothy Bonawit Kole SchoolJ.H.S. 067 Louis PasteurJ.H.S. 118 William W. NilesJ.H.S. 144 MichelangeloJ.H.S. 157 Stephen A. HalseyJ.H.S. 190 Russell SageJ.H.S. 194 William CarrJ.H.S. 201 The Dyker HeightsJ.H.S. 202 Robert H. GoddardJ.H.S. 259 William MckinleyJ.H.S. 74 Nathaniel HawthorneJohn D. Wells (M.S. 50)Jonas Bronck AcademyKamit Preparatory InstituteKIPP Infinity Middle SchoolKIPP Washington Heights Middle SchoolLeadership Prep Brownsville Middle AcademyLeadership Prep Ocean Hill Middle AcademyLouis Armstrong Middle School (I.S. 227)Lower Manhattan Community Middle SchoolM.S. 131 Sun Yat SenM.S. 137 America’s School of HeroesM.S. 158 Marie CurieM.S. 180 Dr. Daniel Hale WilliamsM.S. 216 George J. RyanM.S. 324 – Patria MirabalM.S. 354 – The School of Integrated LearningM.S. 358M.S. 51 William AlexanderManhattan Academy of Technology/Jacob Riis (P.S. 126)Math & Science Exploratory SchoolMott Hall IIMott Hall IIIMS 204 (Oliver Wendell Holmes)MS 216 GEORGE J. RYANMS 244 – New School for Leadership and the ArtsMS 245 The Computer SchoolMS 915NONENYC Lab Middle SchoolOur World Neighborhood Charter SchoolP.S. 007 Samuel SternP.S. 071 Rose E. ScalaP.S. 123P.S. 184 Shuang WenP.S. 189 The Bilingual CenterP.S./I.S. 119 The GlendaleP.S.M.S. 124 Osmond A. ChurchPark Slope CollegiatePelham Gardens Middle SchoolPort Morris (P.S./M.S. 5)Preparatory Academy for WritersPS 102 – BayviewPS 580PS/IS 266QQueens United Middle SchoolQuest to LearnRachel Carson (I.S. 237)Robert F. Wagner, Jr. Secondary School for Arts and TechnologyRoy H. Mann – I.S. 78School In The SquareSouth Woods Middle SchoolSt. Mary’s Elementary SchoolSuccess Academy Bronx 2Success Academy Harlem EastTeachers College Community SchoolThe Bronx School of Young LeadersThe Calhoun SchoolThe Christa McAuliffe School I.S. 187The Creston Academy for Responsibility and Excellence (C.A.R.E.)The Gordon Parks School for Inquisitive MindsThe Park Slope Educational Complex at (M.S. 88)The School at Columbia UniversityThurgood Marshall Academy for Learning and Social ChangeTown SchoolTrinity SchoolUrban Assembly Academy of Arts and Letters M.S. 492Urban Assembly Institute of Math and Science for Young WomenValley Stream South High SchoolWoodmere Middle SchoolWorld Journalism Preparatory: A College Board SchoolYork Early College AcademyYoung Women’s Leadership School, Astoria
Only if your Middle School is not listed above, write it here:
15. Middle School Borough: –Choose–ManhattanQueensBrooklynBronxStaten IslandOther
16. Did you take the SHSAT (Specialized High School Admission Test)? –Choose–YesNo
17. Are you currently in the 8th grade and either living in New York City or attending a New York City middle school: –Choose–Yes, I live in New York City and attend a New York City middle school.Yes, I live in New York City but do not attend a New York City middle school.Yes, I attend a New York City middle school but do not live in New York City.No (Sorry, the SLI is only available to 8th grade students living in or attending a school in New York City).
18. Ethnicity: Choose the one you most consider yourself to be. –Choose–Black/African American (non-Latinx)Black & Latinx / Afro-LatinxLatinxNative AmericanSouth AsianSoutheastern AsianEast AsianMiddle EasternAsianWhiteBiracial (see next question for further detail)
Only if you’re Biracial, please indicate which race or ethnicity you identify as (e.g. Black and Asian; Latinx and White).
19. What languages do you speak at home? (please check all that apply) –Choose–EnglishSpanishBanglaMandarinCantoneseArabicHaitian CreoleOther
Only if Other, please write the language you speak at home.
20. On a scale from 1-10, with ten the highest, rate your enthusiasm for participating in the Summer Law Institute (SLI) in Summer 2021.: Choose the one you most consider yourself to be. –Choose–10 Highest987654321 Lowest
21. How did you hear about the Summer Law Institute? Please list the name and relationship of the person who referred you –Choose–Someone from the Summer Law Institute did a presentation at my schoolA brochure or flyer at a local organization (library, rec center, gym, etc.)A teacher/guidance counselor/other school staff memberFriend / family memberA social media ad or postResearchOther
Please list the name and relationship of the person who referred you
22. Do you have a family member (or members) who did the Summer Law Institute or did/is currently doing the College Bound four year program at Legal Outreach?: –Choose–Yes – SLIYes – SLI and College BoundNo or Do Not Know
If your answer to the previous question was YES, please tell us the name of the family member.
23. Who does the student live with?: –Choose–One ParentTwo Parents (same household)Two Parents (separate households)Non-parent guardian(s) (e.g. foster parents; grandparents)Other
24. What are the names of any people living with you and what is your relationship to them? (include yourself, siblings, parents, step-parents, and any other family/friends who live with you full-time):
25. Parent 1’s or Guardian’s Name: Write “NA” if not available.
25. Parent 2’s or Guardian’s Name: Write “NA” if not available.
26. Parent 1’s or Guardian’s Cell Phone: Please provide a valid number. We may need to speak with you about your application. Skip this question if not available.
27. Parent 2’s or Guardian’s Cell Phone: Please provide a valid number. We may need to speak with you about your application. Skip this question if not available.
28. Parent 1’s or Guardian’s Email: Skip this question if not available. Please retype the email to confirm:
29. Parent 2’s or Guardian’s Email: Skip this question if not available.
Please retype email to confirm:
30.
31. This form will not submit unless all required questions have been answered. Follow the directions for each question. Some you can skip and some require you to write “NA” if you can not answer it. If you have any issues e-mail [email protected].