Student Application for Admission Fall 2017
ThankyouforyourinterestinjoiningtheBenjaminBannekerschoolcommunity.
PleasenotethatApplicationsmustbereceivedbyMarch7,2017.Siblingsof
currentstudentsandCambridgeresidentsaregivenpreferenceforavailable
openings.Formoreinformationandtheapplicationcalendarpleasegotoourwebsite
www.banneker.orgPleasereadandcompletebothsidesofthisapplication.
Have you ever applied to Banneker before?
Are you applying to other charter schools?
How many of your children are applying to Banneker this year?
How many school age children do you have in your household?
Your Child’s Information
Last Name
First Name
Date of Birth mm/dd/yy
(fill in below)
Middle Name
Circle Child’s Gender
Male Female
Circle Grade Applying for
PK K
1
2
Street address & apt#
City and zip code
3 4 5 6
Apt#
Zip
Your Child’s School Information
Select your child’s current grade
Name of current school or day care
Located in which city/town
(fill in below)
Parent or Guardian Information
Last Name
First Name
(fill in below)
Middle Name
Please specify your relationship to this child (Mother,
Father, Guardian, etc.)
Street address & apt#
City and zip code
Email address
Best telephone number
Please list any brothers or sisters that already attend Banneker below
Siblings names
X____________________________ _________________________________ _________
Parent/Guardian Signature
Please sign both sides
Application Date
Pleasereadandsignbothsidesoftheapplicationandemailto:[email protected]
orsendtoBenjaminBannekerCharterSchool,21NotreDameAvenue,Cambridge,MA,
02140.Attn:SharonLombara.Pleasecall617-497-7771x202toconfirmreceipt.
Benjamin Banneker Application for Admission Fall 2017
Information you should know. Please Read Carefully:
Benjamin Banneker is a tuition free K1 – 6 Charter Public School
To become a two-year K student, child would need to be 4 by March 31, 2017
To become a one-year K student, child would need to be 5 by October 1, 2017
Last day for applications will be 5:00 PM on Tuesday, March 7, 2017
Siblings of current Banneker students are given preference for available openings
Cambridge residents are also given preference for available openings
Lottery on Wednesday, March 8, 2017 at 1:30 in the BBCPS administration building.
Lottery will be delayed 1 day if there is a snow day and school is closed
After provisional acceptance you must provide birth certificate and proof of residency
Proof of residency may include rent receipt, utility bill, copy of license
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For more information request the application FAQS or visit our website and select APPLY
Third Party Information
A third party can ask for the names and addresses of students to be sent to a third party
mail house for bulk mailings, unless we have this form with NO, I do not want my child’s
information shared. If we have your permission, please check off Yes otherwise no,
__Yes You have my permission to share my child’s information
___No I do not want my child’s information shared
How did you hear about Banneker?
Charter School Fair
Daycare Provider
Family or Friends
Other (please describe below)
(Check all that apply)
Newspaper/ Magazines
Bill Board/Outdoor posters
Internet Search/Web Site
Social Media (Facebook, Twitter,)
Open House
Benjamin Banneker Charter Public School complies with all applicable Commonwealth and Federal
Law having to do with non-discrimination and does not discriminate on the basis of race, color, sex,
gender identity, religion, national origin, creed, ethnicity, sexual orientation, mental or physical
disability, age, ancestry, athletic performance, special need, proficiency in the English language or a
foreign language or prior academic achievement in its educational programs or activities pursuant to
Massachusetts General Laws, Chapter 151B and 151C, Title VI of the Civil Rights Act of 1964; Title
IX of the Education Amendments of 1972; M.G.L. c76, s5, Section 504, Rehabilitation Act of 1973;
Americans with Disabilities Act, and regulations promulgated thereunder, 34 C.F.R. Part 100 (Title
VI), Part 106 (Title IX) and Part 104 (Section 504).
Acknowledge and Submit Your Application
Please acknowledge that you have read and completed this application for the
student listed above by signing your name and date below. If you have to apply for
another child you will have to complete another application.
Parent/Guardian please sign and date your application below.
X
Parent/Guardian Signature
Application Date
Pleasereadandsignbothsidesoftheapplicationandemailto:
[email protected],21Notre
DameAvenue,Cambridge,MA,02140.Attn:Applications.Pleasecall617-497-7771x
202toconfirmreceipt.