2019-2020 Rhode Island Public Charter School Lottery Application
2019-2020 Rhode Island Public Charter School Lottery Application
BLACKSTONE ACADEMY
CHARTER SCHOOL

This application must be completed by February 25, 2019 in order to be valid. Lottery will be held on March 1, 2019.
Student Information
Last Name *
First Name *
Middle Name
Street Address *
City Address *
Zip Code
Date of Birth *
MM
/
DD
/
YYYY
District of Residency *
Grade Applying for *
Current School *
Current Grade *
Parent/Guardian Information
Name *
Phone Number *
E-mail address *
Relation to the Child *
Other Parent/Guardian Information
Optional
Name
Phone Number
E-mail Address
Relation to the Child
Additional Information
Does the above applicant have a brother or sister currently enrolled in the school? *
If yes, please provide the brother or sister's name
Is another brother or sister also applying on a separate form? *
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 *
Type name in box to sign
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.
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