New York State Charter School Uniform Application Form
Transcription
New York State Charter School Uniform Application Form
New York State Charter School Uniform Application Form Elmwood Village Charter School 40 Days Park, Buffalo NY 14201 716-886-4581 - ph 716-348-3707 - fax 2015-2016 Lottery Application Applicable School Year: Name of Charter School: Contact Information for Charter School: Application Postmarked by: Lottery Date and Location: 40 Days Park Buffalo, NY 14201 Directions for Submission of Applications: 2015-2016 Elmwood Village Charter School 40 Days Park Buffalo, NY 14201 (716) 886-4581 lgladysz@elmwoodvillageschool.org www.elmwoodvillageschool.org March 31, 2015 Thursday, April 2, 2015 6pm. The Lottery is open to all families, applicants will be notified by mail within 2 weeks of lottery. Results will not be given over the phone. Applications are available online at http://www.elmwoodvillageschool.org/adminRegForm.html or you may stop in the main office between 8am - 4pm M-F to pick one up or call with your complete name and address and we will send in the mail. ALL applications must be post marked by March 31, 2015, to be eligible for the 2015-2016 EVCS Lottery. Kindergarten students MUST be 5 years old by December 31st of the year for which you are applying. Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, national origin, religion or ancestry. A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an application for admission to that school. Elmwood Village Charter School gives preference to siblings of current students & Buffalo residents. Elmwood Village Charter School Open House Dates: Thursday, 1/15/ 2015 - 6 to 7:30 pm & Wednesday, 2/4/ 2015 - 8:30 to 10:30 am You do not need to make a reservation; you may come to one or both. Page 1 of 2 A separate application must be completed and submitted for each child applying for admission. All applications in grades 1st – 8th go directly to a wait list. Elmwood Village Charter School gives preference to siblings of current students and Buffalo residents. Applicant Student Information: 1. Name (Last, First): ____________________________________________ 2.Date of Birth (MM/DD/YYYY): 3. Gender (circle one): Male / Female 4.Home Address (street address, city, state, zip code): _____________________________________________ _____________________________________________ 5. GRADE APPLYING FOR: Grade: _____________ Kindergarten students MUST be 5 years old by December 31st, 2015 to apply. 6. Does the applicant student have a sibling(s) who is also applying? If yes, list sibling’s name, and grade applying for. Yes / No ______________________________________ _____ ______________________________________ _____ ______________________________________ _____ Parent/Guardian Information: 1. Name (Last, First): 2. Relationship to Student: 3. Address (street address, city, state, zip code): _____________________________________________ _____________________________________________ 4. Phone Number(s): 5. Email Address(es): Parent/Guardian Signature: ______________________________ Date: ________________ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~for office use only~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Student Name: _______________________________Grade: ______ Date received: ______ Page 2 of 2