STUDENT APPLICATION FORM
2023 - 2024
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Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender
Clear selection
Current School or Daycare (if any)
Grade Applying for (check only one grade) *
How did you hear about us?
Clear selection
Primary Caretaker #1
Name *
Street Address *
City, State *
Zip Code *
Phone Number (H) *
Phone Number (W)
Phone Number (C)
Email
Relationship to Child *
Primary Caretaker #2
Name
Street Address
City, State
Zip Code
Phone Number (H)
Phone Number (W)
Phone Number (C)
Email
Relationship to Child
Application Information
Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, gender, national origin, religion or ancestry. A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for the applicant to either receive or submit an application for admission to that school.

Notes:
• Items marked with an asterisk (*) are the only items that may be required in order to apply to this charter school. Any items not marked by an (*) are optional.
• Your child must be 5 years old by December 31, 2022 to be eligible for kindergarten, and 4 years old for Pre-K. Siblings and students living in Community School District 3 have admissions preference.
• All applications received by 5 pm, April 3, 2023 are eligible for lottery (first come, first served thereafter).
• A lottery will be held at 10 am, April 4, 2023 should there be more applications than available slots.
You may contact us at the following:
Harlem Link Charter School
21 West 111th Street, Room 137
New York, NY 10026

Phone (212) 289-3249 | Fax (646) 514-1497

info@harlemlink.org
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