Waitlist Enrollment for 2018/19
Please fill out this form to place your child on the 2018/19 waitlist.
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student Gender *
Student Date of Birth *
MM/DD/YYYY
Your answer
What grade will your student be in next school year? (2018/19) *
This is the grade level lottery you are entering your child into.
Does the student have exempt status? *
What is/are the sibling(s) name and age?
Your answer
What is the student's race? *
Please check current grade.
Please check current school. *
Does the student have an existing IEP? If Yes, Please provide a copy of the plan from your current school to the main office with your registration packet. A transition meeting is required. *
Does the student have an existing READ plan? If Yes, Please provide a copy of the plan from your current school to the main office with your registration packet. A transition meeting is required. *
Does the student have an existing 504? If Yes, Please provide a copy of the plan from your current school to the main office with your registration packet. A transition meeting is required. *
Does the student have an existing ALP? If Yes, Please provide a copy of the plan from your current school to the main office with your registration packet. *
Please explain any special medical considerations. Please describe any allergies, medications, or special medical needs.
Your answer
Has the student been expelled or suspended from school. (If yes, please explain) *
Your answer
Parent/Guardian 1 Email Address *
Lottery form and results will be sent to the email address provided
Your answer
Parent/Guardian 2 Email Address
Your answer
Student Mailing Address (Street or PO Box) *
Your answer
Student Mailing Address (City) *
Your answer
Student Mailing Address (State) *
Your answer
Student Mailing Address (Zip code) *
Your answer
Student Physical Address If different from Mailing Address
Your answer
Student Home Phone * (incl. area code) *
Your answer
Parent/Guardian 1 FULL NAME *
Your answer
Relationship to Student *
Parent/Guardian 1 Home Phone (incl. area code) * xxx-xxx-xxxx *
Your answer
Parent/Guardian 1 Mobile Phone (incl. area code) xxx-xxx-xxxx *
Your answer
Parent/Guardian 1 Work Phone (incl. area code) xxx-xxx-xxxx
Your answer
Parent/Guardian 1 Place Of Employment *
Your answer
Is Parent/Guardian 1 mailing address the same as the Student? * if No, please complete the following sections *
Parent/Guardian 1 Mailing Address (Street or PO Box)
Your answer
Parent/Guardian 1 Mailing Address (City)
Your answer
Parent/Guardian 1 Mailing Address (State)
Your answer
Parent/Guardian 1 Mailing Address (Zip code)
Your answer
Parent/Guardian 2 FULL NAME
Your answer
Relationship to Student
Parent/Guardian 2 Home Phone (incl. area code) xxx-xxx-xxxx
Your answer
Parent/Guardian 2 Mobile Phone (incl. area code) xxx-xxx-xxxx
Your answer
Parent/Guardian 2 Work Phone (incl. area code) xxx-xxx-xxxx
Your answer
Parent/Guardian 2 Place Of Employment
Your answer
Is Parent/Guardian 2 mailing address the same as the Student? if No, please complete the following sections
Parent/Guardian 2 Mailing Address (Street or PO Box)
Your answer
Parent/Guardian 2 Mailing Address (City)
Your answer
Parent/Guardian 2 Mailing Address (State)
Your answer
Parent/Guardian 2 Mailing Address (Zip code)
Your answer
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