2024-2025 School Year - Black River Public School Lottery Application Form 

Black River Public School 2024-2025 Lottery Application Form 

  • IMPORTANT -  A separate lottery application form must be filled out for EACH student applying for enrollment. BRPS does not confirm the status of multiple applications for one family. 
  • DO NOT USE AUTOFILL -  DO NOT USE AUTOFILL
  • If you are unable to submit the form online or have no WIFI access, please contact Kelli Heneghan, Enrollment Coordinator at 616-355-0055, ext. 116 to schedule an appointment to fill out the form.
  • This lottery application form must be filled out completely and submitted by February 28, 2024 at 4:00pm to be included in the 2024-25 school year enrollment lottery. Lottery results are mailed via USPS First Class mail in Mid-April.  
  • If your form is submitted after 4:00pm on February 28, 2024, your student will be automatically waitlisted after all students who submitted forms by the deadline. There is no exception to this rule. 
  • Si necesita ayuda rellenando este formulario en español. Comuníquese con John Donnelly, Decano de Estudiantes, al 616-355-0055 x 119 para obtener traducción.
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Email *
Student Last Name: *
Student First Name: *
Sudent Gender: *
Student Birth Date (mm/dd/yyyy): *
Kindergarten students must be 5 years old on or before 09/01/2024, or 5 years old on or before 12/01/2024 for early kindergarten applicants. 
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Name of Student's Current School: *
Student's Current Grade: *
This is the grade your student is in today. 
Student's Grade for the 2024-2025 School Year: *
This is the grade your student will be entered in for the lottery. You will not be notified if there is a discrepancy in the current grade and grade for Fall 2024. Please make sure this grade is accurate.
Student Residence: Primary Street Address: *
Example: 123 Maple Drive (the NEXT field will ask for City, State, and Zip Code)
Student Residence: City, State, and Zip Code: *
Example: Holland, MI 49423
Is this student the child of a Black River Public School full-time faculty or staff member? *
Does this student have a sibling(s) currently attending Black River Public School? *
Name (First and Last) and current grade of ONLY the YOUNGEST sibling currently enrolled at Black River Public School:
Use this format - John Smith, Grade 4  (Only list ONE student) 
Does this student have siblings also applying to BRPS for the 2024-2025 school year? *
A separate lottery application must be filled out for EACH student applying for enrollment. BRPS is not responsible for following up on sibling applications. 
Name and Grade (in Fall 2024) of sibling #1 of the student applying for the 2024-2025 school year:
Use this format - John Smith, Grade 4
Name and Grade (in Fall 2024) of sibling #2 of the student applying for the 2024-2025 school year:
Use this format - John Smith, Grade 4
Name and Grade (in Fall 2024) of sibling #3 of the student applying for the 2024-2025 school year:
Use this format - John Smith, Grade 4
Name and Grade (in Fall 2024) of sibling #4 of the student applying for the 2024-2025 school year:
If you are applying for 5 or more students please contact Kelli Heneghan at heneghank@brpsk12.org
Select Multiple:  Is this student one or more of these races?
The U.S. Department of Education requires that parents answer this question.
Does your student have an Individualized Education Plan (IEP)? *
Enter below any special services received at previous school, including Speech, Social Work, ESL, Resource Room, LD, EI or EMI, or Self Contained Classroom.
Parent/Guardian Information:
Parent/Guardian #1 - First Name Only:
*
Parent/Guardian #1 - Last Name Only:
*
Parent/Guardian #1 Address (if different from student):
Parent/Guardian #1 Relationship to Student: *
Parent/Guardian #1 Primary Contact Phone Number:
Only this number will be called with questions and/or offers of enrollment.
*
Parent/Guardian #1 Cell Phone Number:
Parent/Guardian #1 Email Address *
Does Parent/Guardian #1 have legal custody of the student? *
Parent/Guardian #2 First Name:
Parent/Guardian #2 Last Name:
Parent/Guardian #2 Relationship to student:
Parent/Guardian #2 Address (if different): 
Parent/Guardian #2 Phone Number:
Parent/Guardian #2 Email Address:
Does Parent/Guardian #2 have legal custody of the student? 
If a second parent/guardian is listed this question must be answered. 
How did you hear about BRPS? *
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