MCCPS Lottery Application for Admission 2018
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 2018 *
Child's First Name *
Your answer
Child's Middle Name
Your answer
Child's Last Name *
Your answer
Home Street Address *
Your answer
Home Town or City *
Marblehead residents will need to provide evidence of residency.
Home Zip Code *
Your answer
Home Phone Number *
ex. 617-555-1234
Your answer
Home State *
City of Birth *
ex. Salem
Your answer
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
Your answer
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
Your answer
Student resides with *
Mother's / Guardian 1 Name *
Your answer
Mother's / Guardian 1 Street and Town
only if different from child's home address
Your answer
Mother's / Guardian 1 Employer
Your answer
Mother's / Guardian 1 Workplace or Cell Number
Your answer
Father's / Guardian 2 Name *
Your answer
Father's / Guardian 2 Street and Town
only if different from child's home address
Your answer
Father's / Guardian 2 Employer
Your answer
Father's / Guardian 2 Workplace or Cell Number
Your answer
Does your child have a sibling currently attending MCCPS *
Parent Email *
Your answer
Submit
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