2020-2021 Student Admissions Application for The Emerson School
Email address *
Student Last Name: *
Your answer
Student First Name: *
Your answer
Gender: *
Birthdate: *
Must be 5 years of age by 9/1/20 for KG admission
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Grade entering in September: *
Primary Address *
Include Address (include apartment number, if applicable), City, State and Zip Code
Your answer
Parent 1 First and Last Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Phone *
If you are placed on our waiting list we will most likely be contacting you over the summer or during the school year. Keep us informed of any changes to your phone numbers or email addresses during that time.
Your answer
Parent 2 First and Last Name
Your answer
Parent 2 Email
Your answer
Parent 2 Phone
Your answer
Secondary Address (if applicable)
Include Street Address, City, State and Zip Code
Your answer
Who does the child live with? *
My child lives within the Portland School District. *
Required
If yes, list name of child's neighborhood school. *
Your answer
My child lives within a different school district *
Required
If yes, list name of school district & school
Your answer
My child is currently enrolled in: *
Please list the name of your child's current school. *
Your answer
Are there siblings applying to The Emerson School *
List Siblings Name(s), Age(s) and Grade(s)
Your answer
Demographic Information (questions 1-3 are optional and for lottery purposes only)
Historically underserved students who meet at least two of the four identified historically underserved criteria will be entered into the lottery three times (as opposed to one time for other students):
• Historically underserved students based on race (includes only: African American, Pacific Islander/Native Hawaiian,
American Indian/Alaska Native)
• Historically underserved students based on ethnicity (includes only Hispanic)
• Economically disadvantaged students (Directly Certified/Free and Reduced Priced Meals Program & Head Start)
• English language learners
1) Race (select at least one):
Answering the following question about race is optional. Your answer will help The Emerson School determine your child's status for the purpose of our weighted lottery process.
2) Ethnicity: Hispanic/Latino?
Answering the following question about ethnicity is optional. Your answer will help The Emerson School determine your child's status for the purpose of our weighted lottery process.
3) My child is currently enrolled in the following programs and/or receives the following services:
Answering the following question is optional. Your answer will help The Emerson School determine your child's status for the purpose of our weighted lottery process.
Is there a language other than English spoken at home *
This information is not considered for lottery purposes
If yes, what language is used?
Your answer
Is it the child’s primary language?
How did you hear about The Emerson School? *
I have attended an informational meeting and/or read The Emerson School’s printed information. I understand the school’s philosophy and believe this is a good match educationally and philosophically for my child and family. *
I have attended an open house. Or, I have not attended an open house, but will enroll my child without seeing the school. *
I understand that The Emerson School’s program will provide a wide variety of experiences for my child, including spending school time outside the classroom engaged in community studies and community service projects. *
I authorize the release of my child’s school records to The Emerson School. *
I understand the official policy regarding application submission to the Emerson School Applicants are responsible for assuring their applications have been received by The Emerson School. Applicants will receive an email acknowledging receipt of application upon submission. *
Required
My initials indicate I have read and understood everything on this form. *
Your answer
I understand applications must be received by Friday, March 20, 2020 at 5:00pm PST to be considered in the lottery. All applications received after March 20 will be placed on the waitlist in order of date received. Lottery results will be sent by email on or before April 10, 2020. *
I have read The Emerson School's Equal Opportunity Statement: The Board and employees of The Emerson School represent a diverse group of people who have a common commitment to the equality of opportunity for all. The Emerson School is an equal opportunity organization that does not discriminate on the basis of ethnicity, race, gender, sexual orientation, age, religion, marital status, national origin, or mental or physical disability. *
A copy of your responses will be emailed to the address you provided.
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