MCCPS Lottery Application for Admission 2019-20
Applications submitted after February 15th will be added to our waitlist as additional spaces open up.
The grade your child will enter in the fall of 2019 *
Child's First Name *
Child's Middle Name
Child's Last Name *
Home Street Address *
Home Town or City *
Marblehead residents will need to provide evidence of residency.
Home Zip Code *
Home Phone Number *
ex. 617-555-1234
Home State *
City of Birth *
ex. Salem
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Child's Ethnic Background *
This question is not used for selection purposes
Name and Town of Your Child's Current School *
ex. Bell School Marblehead
Is your child receiving special services at their school? *
This question is not used for selection purposes
If your child is receiving special services, what type of service do they receive?
This question is not used for selection purposes
Language spoken at home
Student resides with *
Mother's / Guardian 1 Name *
Mother's / Guardian 1 Street and Town
only if different from child's home address
Mother's / Guardian 1 Employer
Mother's / Guardian 1 Workplace or Cell Number
Father's / Guardian 2 Name *
Father's / Guardian 2 Street and Town
only if different from child's home address
Father's / Guardian 2 Employer
Father's / Guardian 2 Workplace or Cell Number
Does your child have a sibling currently attending MCCPS *
Parent Email *
Submit
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