2019-2020 Lottery Application
Please complete the form below to be considered for enrollment during the 2019-2020 school year.
STUDENT INFORMATION
Grade for Fall 2019 *
Student Name *
First, Middle, & Last Name
Your answer
Name student goes by
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Student resides with: *
Enter the name of the person the student lives with.
Your answer
Relationship: *
The person the student lives with is what relationship to the student? (Parent, grandparent, guardian, etc)
Your answer
Current School *
Your answer
Special Educational Needs *
Required
Free & Reduced Lunch Participant *
PARENT INFORMATION
Mother's Name *
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Mother's Primary Email *
List an email address that you check regularly. This is our main method of communication.
Your answer
Mother's Primary Phone Number *
List the phone number that you prefer for school communications.
Your answer
Father's Name *
Your answer
Street Address (if different from above)
Your answer
City (if different from above)
Your answer
State (if different from above)
Your answer
Zip (if different from above)
Your answer
Father's Primary Email
List an email address that you check regularly. This is our main method of communication.
Your answer
Father's Primary Phone Number
List the phone number that you prefer for school communications.
Your answer
Sibling Information
Does the student have a sibling applying to Lead Academy at this time? *
Name of sibling:
If applicable
Your answer
How did you hear about Lead Academy? *
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