Class/Homeroom IDNYC Middle School Card Application

IDNYC Middle School Card Application

Class/Homeroom

For internal use only

For Students at Participating NYC Department of Education (DOE) Middle Schools

APPLICANT INFORMATION All information must be written in black/blue ink

1. First/Given Name(s):

2. Middle Name or Initial:

3. Last Name(s): 4. Date of Birth: M M / D D / Y Y Y Y 5. Eye Color: BROWN

HAZEL

BLACK

BLUE

GREEN

GRAY

MULTICOLOR

6. Height:

FEET

INCHES

7. Gender: FEMALE

MALE

X (NOT MALE OR FEMALE)

NOT DESIGNATED

8. School DBN and Name:

9. Language Preference (Including ASL):

10. Student' s current grade:

HOME ADDRESS (must match Student' s DOE profile): This address will not appear on the card

11. Number and street:

City:

Borough (?check one): BRONX

BROOKLYN

12. Designate an Emergency Contact on the Card (Required for applicants under 14 years old):

FIRST NAME

LAST NAME

MANHATTAN

State: N Y

QUEENS

Phone:

Apt. # / Fl. / Ste. / Unit / Rm.

Zip Code:

STATEN ISLAND

-

-

PARENT, GUARDIAN, OR CUSTODIAN 13. First/Given Name(s): 14. Middle Name or Initial: 15. Last Name(s):

16. Email: Your email/phone will be used for internal purposes only

Phone:

-

-

PARENT, GUARDIAN, OR CUSTODIAN AFFIRMATION

18 a. I a rm that I am the applicant's parent, guardian, or custodian named above; that the applicant lives in the City of New York; and attends the NYC DOE middle school named above; and that all statements made on this application are true to the best of my knowledge. I hereby authorize the principal at the school named above, or their designee, to (1) verify that the information on this application matches the applicant's information in the NYC Department of Education's records; and (2) assist the applicant in applying for the IDNYC Middle School Card.

AFFIRMATION OF SCHOOL PRINCIPAL (OR DESIGNEE)

18 b. I a rm that I am the Principal of the school named above (or their designee), at which the applicant is enrolled as a student. I confirm that I have compared the student's name, date of birth, home address, and school on this application to the student's NYC Department of Education's records, and that they match.

NAME OF PARENT / GUARDIAN / CUSTODIAN (PRINT)

SIGNATURE OF PARENT / GUARDIAN / CUSTODIAN

M M/D D/Y Y Y Y

Date

SIGNATURE OF SCHOOL PRINCIPAL OR DESIGNEE

M M/D D/Y Y Y Y

Date

IDNYC-20 (E) Rev. 1/20

Application Questions and Answers

What is an IDNYC Middle School Card? An IDNYC Middle School Card is a government identification card available to students at participating NYC Department of Education middle schools. Any middle school student 10 years or older who lives in New York City and attends a participating DOE middle school may apply for an IDNYC Middle School Card.

How should the application be completed? Please provide the following information:

Applicant Information: Provide student's name, date of birth, height, eye color, gender, and student's current grade. Adding the student's language preference is optional. School DBN should be provided. The student's name and date of birth on the application must match the information in the student's school profile.

Home Address: Provide student's home address (this will not appear on card). The home address on the application must match the information in the student's school profile.

Emergency Contact: Provide the name and phone number of an emergency contact (this will appear on the card). This is required for 10-13 year olds and optional for those 14 and older.

Parent, Guardian, or Custodian: Provide the name, email, and phone number of the student's parent, guardian, or custodian. The parent/guardian/custodian's information on the application must match what is in the student's school profile.

Parent, Guardian, or Custodian Affirmation: The student's parent, guardian, or custodian must sign the affirmation at the bottom left-hand side of the application. Please DO NOT sign the School Principal affirmation at the bottom right-hand side of the application.

Edits on the application are not permitted. To download a new copy of the application please visit

idnyc/middleschool

What will appear on the card? The student's name, date of birth, height, photo, gender (unless the "not designated" option is selected), signature, emergency contact (required for students under 14, optional for students 14 and over), and school name will appear on the IDNYC Middle School Card. Applicants may also choose to list a language preference on the card. The student's home address will not appear on the card.

Is there an age requirement to apply for the card? Students must be at least 10 years old to apply for an IDNYC Middle School Card.

What are the gender options on this card? The gender options are female, male, X, or leaving the gender field blank. The designation "X" is a non-binary gender designation. Non-binary means a designation that is neither male nor female.

How much will the IDNYC card cost? The IDNYC Middle School Card is free.

What expiration date will appear on the card? The expiration date printed on the card will be the date when the student is expected to graduate from middle school.

What can my child do with their IDNYC? Free memberships at museums and cultural institutions throughout the city; Discounted tickets to plays, sports events, and other events; Discounts on numerous other benefits, including classes, sports goods, fitness and health clubs; Check out books at all Brooklyn, Queens, and New York Public Library Branches, and much more.

Find out more at idnyc/benefits

How will my child receive their IDNYC Middle School Card? Your child's IDNYC Middle School Card will be delivered to your child's school and distributed by a school administrator.

How will the City protect my personal identity and residency information? The City will protect the confidentiality of all IDNYC applicants to the maximum extent allowable by applicable federal and state law, and in accordance with NYC Administrative Code Section 3-11

For questions call 311 or visit IDNYC

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