KIPP Reach College Preparatory Pre-Enrollment Application
Completion of this form demonstrates your desire to enroll your child at KIPP Reach College Preparatory.

KIPP Reach serves 5th-8th grade students only.

Please complete 1 form per child you wish to enroll.

Student Information
Student OKCPS Student ID # (This is your child's Lunch ID #)
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Last Name *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Address
** Lottery Results will be mailed to this address unless the school is notified of any address change.**
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
School Information
Current Grade as of Today (KIPP Reach only serves students in 5th - 8th grade) *
Current School *
Your answer
Current School Telephone Number
Your answer
Does Student have an IEP? *
Parent Information
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Street Address (if different from above)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Telephone Number - including area code *
Your answer
Work Telephone Number
Your answer
Spouse/Other Guardian/Non-Custodial Parent Information
First Name
Your answer
Last Name
Your answer
Relationship to Student
Your answer
Phone Number
Your answer
Work Phone Number
Your answer
Recruitment Information
Does the student applying have a sibling who is attending or graduated from KIPP Reach? *
Name of KIPP Reach Sibling
Your answer
Sibling's Current Grade or Year Graduated
Your answer
Do you know another student who might be interested in KIPP Reach College Prep? What is the student's name and grade?
Your answer
Parent's Name
Your answer
Phone Number
Your answer
Please read the following statement: I understand that as part of KIPP Reach College Preparatory’s commitment to continual improvement, KIPP Reach College Preparatory is involved in studies of student outcomes. In submitting this application, I grant permission for KIPP Reach College Preparatory or its research partner, Mathematica Policy Research, to request the school records of the student for whom I am submitting this application, including such information as my child's attendance, test scores, or other academic outcomes, for the duration of the study. I further understand that this information may be used for studies of KIPP Reach College Preparatory and that all student-level information will remain confidential as required by the Family Educational Rights and Privacy Act (FERPA). My decision whether or not to participate in the study will have no impact on my child’s likelihood of admission to KIPP Reach College Preparatory. Further, there are no discernible risks to participating in the study and while there are no direct benefits to myself or my child, KIPP and society at large may benefit from the increased knowledge about potential KIPP student achievement and parental satisfaction. If you have any questions about the study or your child’s participation, please contact Lisbeth Goble at Mathematica’s toll-free number, 1-877- 523-4651. For questions about your rights as a research participant, or if you feel that you have been harmed in any way as a result of study participation, please contact Margo Campbell at Public/Private Venture’s IRB at toll-free 1-800-755-4778 x4446. *
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