2020-2021 Rhode Island Blackstone Academy Charter School Lottery Application Responses
BLACKSTONE ACADEMY CHARTER SCHOOL

This application must be completed by Monday February 24, 2020 in order to be valid.
Lottery will be held on March 2, 2020.
Email *
Student Information
Last Name *
First Name *
Middle Name
Street Address *
City Address *
Zip Code *
Date Of Birth (Month/Day/ Year) *
MM
/
DD
/
YYYY
District of Residency *
Grade Applying For *
School Currently Attending *
Current Grade *
Parent/ Guardian Information
Name *
Phone *
Email *
Relation to the Child *
Other Parent/ Guardian Information
Name
Phone
Email
Relation to the Child
Additional Information
Does the applicant have a brother or sister currently enrolled in this charter school? *
If yes, please provide the brother or sister's name.
Does the applicant have a brother or sister applying to this school on a separate application? *
If yes, please provide the brother or sister's name
Signature
I affirm that the information contained in this application is, to my knowledge, completely true.
Parent/Guardian Signature *
I agree that my child’s school records may be used for studies on the effectiveness of public charter schools. If the studies are publicized, only group data, not student level data, will be reported. Sensitive student information will remain confidential under state and federal law. *Note: Checking "No" will NOT affect your child's chances for admission.
Clear selection
A copy of your responses will be emailed to the address you provided.
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