Application for Admission to Martin Luther King, Jr. Charter School of Excellence
Office Use Only
Verification of Grade: ______________
Address: 285 Dorset Street, Springfield, MA 01108
Telephone: (413) 214-7806  Fax: (413) 214-7838  Email: [email protected]
Application Number: _______________
Martin Luther King, Jr. Charter School of Excellence does not discriminate on the basis of race, creed, national origin, ethnicity, religion,
gender, gender identity, sexual orientation, mental or physical disability, age, special needs, English language proficiency, athletic ability or
academic achievement. Your admission application for the February, 2015 application period must be postmarked by Friday, January 30,
2015 and received by Monday, February 2, 2015. The admissions lottery will be held at 10:00 a.m. on Tuesday, February 3, 2015 at MLK
Charter School, 285 Dorset Street, Springfield. Please mark your calendar even though you need not attend the lottery.
STUDENT INFORMATION
Student Name: ___________________________________________________________________
Last
Student is currently in:
_____Kindergarten
_____Grade 1
_____Grade 2
_____Grade 3
_____Grade 4
_____Grade 5
_____Student will enter
Kindergarten in Sept. 2015
First
Full Middle
Birthdate: _______________________
Birthplace: _______________________________________________________
Gender: ________
Address: _________________________________________________________________________
Street
Apt. #
City
State
Zip
Current School: ____________________________________________________  public  private
School Nome
City
State
Past School: _______________________________________________________________________
School Nome
City
State
Grade(s)
Preschool: ________________________________________________________________________
School Nome
City
State
Grade(s)
STUDENT SIBLING INFORMATION
Siblings of children currently attending MLK Charter School receive preference.
Does the applicant student have a sibling already enrolled at MLKCSE?
Does the applicant student have a sibling already on the MLKCSE waiting list?
At this time, are you submitting an application for a sibling of this applicant?
 Yes, Sibling Name______________________
 Yes, Sibling Name______________________
 Yes, Sibling Name______________________
No
No
No
PARENT/GUADIAN INFORMATION
Name: _________________________________________________________________ __________________________________________
Parent/Guardian Last Name
First
Middle
Relationship to child
Address: ___________________________________________________________________________________________________________
Street
City
State
Zip
Telephone: ________________________, ________________________, ________________________
Home
Work
Cell
Name: _________________________________________________________________ __________________________________________
Parent/Guardian Last Name
First
Middle
Relationship to child
Address: ___________________________________________________________________________________________________________
Street
City
State
Zip
Telephone: ________________________, ________________________, ________________________
Home
Work
Cell
PARENT RESPONSE
Why are you applying to MLK Charter School? _____________________________________________________________________________
I heard about MLK Charter School from: _________________________________________________________________________________
PARENT/GUARDIAN STATEMENT
I, the undersigned, understand that when I register the student, I will be asked to sign the Parent/Guardian Partnership Agreement.
I will notify the school of all changes of address and telephone number.
Parent/Guardian Signature: __________________________________________________
Date: __________________________
ABCs of MLK
 Academic Excellence
 Beloved Community - Aspiring to Dr. King’s ideal
 Character Development
285 Dorset Street, Springfield, MA 01108
Tel. (413) 214-7806, Fax (413) 214-7838
www.mlkcs.org, [email protected]
Martin Luther King, Jr. Charter School of Excellence is now accepting applications for students entering
kindergarten in September 2015 and students currently in kindergarten, 1st, 2nd, 3rd, 4th, and 5th grades.
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Children must be born on or before 9/1/10 to be eligible to enter kindergarten in 2015.
Siblings of current students must submit separate applications.
MLKCSE will maintain waitlists only for the school year for which the students applied. Applicants must re-apply yearly.
Current students do not need to resubmit an application for the next school year.
Charter schools are public schools and do not charge tuition.
Martin Luther King, Jr. Charter School of Excellence prepares kindergarten-through-5th grade students of Springfield for
academic success and engaged citizenship through insistence on rigorous, challenging work. The school incorporates Dr. King’s
commitment to the highest standards in scholarship, civic participation and the ideal of the beloved community.
MLKSCE provides:
 Regular education academic support
 Academic support for Limited English Proficient (LEP) students
 Special Education (SpEd) Services
 Dr. King Scholars Scholarship Program
 Community Service Learning Program
Applications can be obtained by:
1. Calling us at (413) 214-7806
2. Emailing us at mlkcs.org
3. Visiting our website at www.mlkcs.org, choose “Enrollment” link
“Intelligence plus character - that is the true goal of education.” – Dr. Martin Luther King, Jr.