Brooklyn Technical High School

Welcome to Brooklyn Technical High School!!!!!!!!

Gateway to Medicine - 8th Graders Pre-Registration

Please complete the form below. Mandatory fields marked *

Student Information

Last Name * :
First Name * :
Middle Initial * :
Date of Birth * : / /
Sex * : Male Female
NYCDOE OSIS# * :
Student's Email Address * :
Name of Junior High/Middle School * :
Phone Number of School * :

Student Contact Information

Students Address * : Apt. # * :
Borough * : Zip Code * :
Full Name of Parent/Guardian * : Home Phone * :
Parent/Guardian Daytime Phone * : Parent/Guardian Cell Phone * :
Parent/Guardian Email Address * :
Please give a working email address, as you will only be contacted by email.

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