2015-2016 Innovation Student Application

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Thank you for applying to the Renaissance Charter High School for Innovation

Student's First Name *

Student's Last Name *

Student is applying for the *

2015-2016 School Year

Student Street Address: *

City *

State *

Zip Code *

Does Student live in NYC Community School District 4? *

Yes

Student date of birth *

YYYY

Student gender *

Female

Male

Transgender

Student's Language *

Student's Current School *

Student's Current Grade *

Student ID # *

Regarding Ethnicity, how does the Student self-identify?

(Optional)

White, not of Hispanic Origin

Black, not of Hispanic Origin

Hispanic

Asian or Pacific Islander

Other

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Parent 1 (Primary Contact) Information

We ask for two Parent / Contacts. This section is for the Primary contact for the student.

Parent 1 (or Primary Contact) First Name *

Parent 1 (or Primary Contact) Last Name *

Parent 1 (or Primary Contact) Phone Number *

Parent 1 (or Primary Contact) Phone Number type *

Home

Cell

Parent 1 (or Primary Contact) Email Address

Is the Parent 1 (Primary Contact) Address the SAME as the Student? *

We ask for 2 Parent contacts. If the PRIMARY contact for this student has the same address, answer Yes

Yes

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