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 address *
Student Information
Last Name *
Your answer
First Name *
Your answer
Middle Name
Your answer
Street Address *
Your answer
City Address *
Your answer
Zip Code *
Your answer
Date Of Birth (Month/Day/ Year) *
MM
/
DD
/
YYYY
District of Residency *
Grade Applying For *
School Currently Attending *
Your answer
Current Grade *
Parent/ Guardian Information
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Relation to the Child *
Your answer
Other Parent/ Guardian Information
Name
Your answer
Phone
Your answer
Email
Your answer
Relation to the Child
Your answer
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.
Your answer
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
Your answer
Signature
I affirm that the information contained in this application is, to my knowledge, completely true.
Parent/Guardian Signature *
Your answer
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.
A copy of your responses will be emailed to the address you provided.
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