21st Century Charter School at Gary Lottery Enrollment Entry - School Year 2019-2020
Complete this form to submit your enrollment Inquiry for our enrollment lottery for School Year 2019-2020. Lottery will be held March 22nd, 2019. The last date to enter lottery is March 8, 2019.

Please complete one form for each child. Note that completing this form does not guarantee enrollment.

Email address *
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's Middle Name
Your answer
Student's Birthday 00/00/0000 *
Your answer
Gender
Has the student ever attended 21st Century Charter School at Gary?
Child's Grade Level in 2019 -2020 School Year *
Last School Attended?
Your answer
Parent/Guardian Last Name, First Name
Your answer
Relationship to Student
Cell Phone Number: 000.000.0000
Your answer
Home Phone Number: 000.000.0000
Your answer
Parent/Guardian E-mail Address
Your answer
Home Address
Your answer
City
Your answer
State
Your answer
Zipcode
Your answer
Does this student have brothers or sisters attending 21st Century Charter School at Gary? If Yes, please list name and grade below:
Your answer
Secondary Contact Name:
Your answer
Secondary Contact Primary Phone Number:
Your answer
How did you hear about 21st Century Charter School at Gary?
Submit
Never submit passwords through Google Forms.
This form was created inside of Geo Academies.