NYCDOE Charter School Forms

NEW YORK CITY COMMON CHARTER SCHOOL APPLICATION 2010-2011 Name of Charter School:_______________________________________________________________
School address:______________________________________________________________________
Deadline: Common applications must be delivered to the school by hand, mail, or email no later than April 1st, 2010. Please contact the school directly to see if any additional information is required prior to the deadline.
Student Information
Student’s Last Name:_________________________________________________________________
First Name:___________________________________________________________ Middle Initial:__
Date of Birth:__-__-____ Student I.D.: _________________ Circle One: (Male/Female)
Address:_______________________________________________, City:_______________________
State:____________ Zip:_______________, Entering Grade for fall 2010:_______________________
Current School:______________________________________________________________________
Community School District where student resides (NYC residents only):_________________________
(Check your Community School District by calling the number 311 or online by entering your address at: (http://gis.nyc.gov/dcp/at/f1.jsp)
Student Information
Student’s Last Name:___________________ First Name:_________________ Middle Initial:__
Date of Birth:__-__-____ N.Y.C. Student I.D.: _________________ Circle One: (Male/Female)
Entering Grade for fall 2010:_____________ Current School:________________________
Community School District where student resides:______________________________
Parent/Guardian Information
Last Name:__________________________________________________________________________
First Name:________________________________________________________ Middle Initial______
Primary Phone: (___)____________ Work Phone:(___)__________ Cell Phone:(___)_________
Email:________________________________
Last Name:___________________________________________________________________________
First Name:________________________________________________________ Middle Initial_______
Primary Phone: (___)____________ Work Phone:(___)__________ Cell Phone:(___)_______________
Email:_________________________________
Siblings
Does the applying student have a sibling attending this charter school? Circle one: (YES/NO)
If so, please list name, grade and date of birth of sibling:
1) Last Name:___________________________________________, Grade:_____________________
First Name:__________________________________________________, Date of Birth:___/___/_________
2) Last Name:___________________________________________, Grade:_____________________
First Name:__________________________________________________, Date of Birth:___/___/_________
At-Risk Categories: This information is optional but providing it may increase your student’s chances of admission to certain schools. Please contact each school that you are interested in before April 1, 2010 to see what, if any, at-risk criteria the school may have and provide such information in the space below. You may also have to provide supporting documentation, if required by the school.
____________________________________________________________________________________________
Agreement
I affirm that the information I have submitted above is true to the best of my knowledge. Additionally, I understand that submitting this application does not guarantee admission to the charter school mentioned above.
Print Name:____________________________________
Signature:______________________________________ Date (month/day/year): __/__/____
Instructions for Completing Common Charter School Application 2010-2011
These instructions will assist you in completing the Common Charter School Application. The Common Charter School Application must be delivered to the desired charter school no later than April 1st, 2010. Please contact each Charter School you are interested in to see if it requires additional information and the date by when such additional information must be submitted. The application may allow the student named in the Student Information section to enroll in the charter school or participate in the designated charter school’s admissions lottery, if one is held. Please keep in mind that a separate application must be completed for every New York City charter school to which the applicant wishes to apply.

1. Write the name and address of the charter school to which you are applying.
a. Reminder: the Common Charter School Applications must be turned in no later than April 1st, 2010.
2. Student information
a. Enter the student’s last name, followed by their first name and middle initial.
b. Enter the student’s date of birth, student ID # (if known), and indicate whether the student is male or female.
c. Enter the student’s legal address.
d. List the grade the student will be entering for the 2010/2011 school year, the school the student is currently attending, and, for New York City residents only, the community school district where the student currently lives.
i. If you are unaware of the student’s community school district, you may find the community school district by entering the student’s address at this website: (http://gis.nyc.gov/dcp/at/f1.jsp) or by calling 311 and providing the operator with your address.
3. Parent/Guardian Information: This information will be used to contact you regarding questions that the school may have AND to provide you with lottery information including the results of the lottery drawing.
a. Enter the parent/guardian last name, followed by their first name and middle initial.
b. Enter the parent/guardian primary phone number, work phone number, cell phone number, and email address if applicable.
c. Repeat (a) and (b) for a second parent/guardian if applicable.
4. Siblings: Students with siblings presently attending the desired charter school are given preference when applying for admission. This may increase your student’s chances of admission depending on the admissions policy of the school.
a. Indicate yes or no regarding whether the applying student has a sibling already attending the desired charter school.
b. If the student listed on the application has a sibling that already attends the desired charter school, enter the name, grade, and date of birth of the sibling.
5. At-Risk Categories: This information is optional but providing it may increase your student’s chances of admission to certain schools. Note: Different schools have different at-risk criteria. Please contact each school directly to find out what, if any, at-risk criteria the school may have and provide such information in the space provided on the application. You may also have to provide supporting documentation, if required by the school.
6. Agreement
a. Print your name, sign your name, and enter today’s date if you (1) agree that the information entered on the Common Charter School Application is correct to the best of your knowledge and (2) understand that submitting this application does not guarantee admission to the charter school mentioned above.