LEAD Charter School Student Application
LEAD Charter School is now enrolling young people who are between 16-21 years old and have attempted high school. To apply for the upcoming or current school year, please complete all fields below. We will invite you to our enrollment center for an information session. LEAD's enrollment center is located at 201 Bergen Street, Newark NJ, 07103. The enrollment center can be reached at 862-772-1724.

Filling out this application does not guarantee admission. It only guarantees inclusion in the enrollment list and process. A registration form will be required next. Visit our website at leadcharterschool.org or call 862-772-1724 for more information regarding the enrollment process.

Student Information
Email Address
Your answer
Student First Name *
Your answer
Student Last Name *
Your answer
Student Middle Name or Initial *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Gender *
Age *
Street Address *
Your answer
City *
If you selected "Other" for city above, please tell us what city you're from.
Your answer
State *
Zip Code *
Your answer
Home Phone Number *
Your answer
Last Grade Attempted *
What was the last school that you attended? *
Your answer
Do you currently have a sibling attending LEAD Charter School? *
If you currently have a sibling(s) that currently attend LEAD Charter School, list the name(s) below. (Enrollment preference is given to siblings of enrolled students per N.J.S.A 36A-8c) Type N/A if this does not apply to you. *
Your answer
What is your relationship to the applicant listed on this form? *
Parent/Guardian Information (Required if under 18 years old)
Guardian #1 First Name
Your answer
Guardian #1 Last Name
Your answer
Guardian #1 Relationship to Applicant
Your answer
Guardian #1 Phone Number
Your answer
Guardian #1 Alternate Phone Number
Your answer
Guardian #1 Email Address
Your answer
Guardian #2 First Name
Your answer
Guardian #2 Last Name
Your answer
Guardian #2 Relationship to Applicant
Your answer
Guardian #2 Phone Number
Your answer
Guardian #2 Alternate Phone Number
Your answer
Guardian #2 Email Address
Your answer
Signatures
Parent/Guardian Signature (typed) - required only if the student is younger than 18 years of age
Your answer
Date of Parent/Guardian Signature
MM
/
DD
/
YYYY
Student Signature (typed) - required only if the student is younger than 18 years of age *
Your answer
Date of Student Signature
MM
/
DD
/
YYYY
Enter referral code, if applicable.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of LEAD Charter School.