Challenge Prep Charter School 710 Hartman Lane Far Rockaway, New York 11691
ChallengePrepCharter.org
718-327-1352 Office Phone
718-327-1361 School FAX
2015-­‐2016 SCHOLAR APPLICATION PLEASE PRINT ALL INFORMATION CLEARLY. ONLY COMPLETED APPLICATIONS WILL BE CONSIDERED. SEPARATE APPLICATIONS MUST BE COMPLETED FOR EACH STUDENT. CHALLENGE PREPARATORY IS A PUBLIC SCHOOL AND DOES NOT DISCRIMINATE IN ANY WAY, INCLUDING ON THE BASIS OF ETHNICITY, NATIONAL ORIGIN, RELIGION, GENDER, OR DISABILITIES. COMPLETED APPLICATIONS MUST BE POSTMARKED, COMPLETED ONLINE @ https://app.jumpro.pe/charterapply#school=134 OR FAXED AND RECEIVED BY 5:00 PM ON FRIDAY, APRIL 3, 2015 Each applying child requires a separate application STUDENT INFORMATION LAST NAME: ____________________________ FIRST NAME: ______________________________ ADDRESS: ___________________________ APT. _____ CITY_____________________ ZIP:_______ th
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GRADE APPLYING: FOR: K _____ 1st ______ 2nd _____ 3rd _____ 4 _____ 5 _____ 6 ______ DATE OF BIRTH: ____/____/_____ GENDER: ____ F _____ M _____I DO ______ I DO NOT CURRENTLY LIVE IN COMMUNITY SCHOOL DISTRICT 27. UNDER NEW YORK STATE LAW, SIBLINGS ARE ELIGIBLE FOR ADMISSION THROUGH SIBLING PREFERENCE. A SIBLING IS DEFINED AS A BROTHER, SISTER, OR OTHER CHILD LEAGALLY UNDER YOUR CARE AND RESIDING IN THE SAME HOUSEHOLD. DO YOU HAVE A SIBLING WHO IS APPLYING TO CHALLENGE PREPARATORY CHARTER SCHOOL? ______ Yes _______ No NAME OF SCHOLAR: _________________________________ FAMILY INFORMATION PARENT/GUARDIAN – RELATIONSHIP TO STUDENT: ______________ LIVES WITH ___ YES ___ NO LAST NAME: __________________________________ FIRST NAME: ___________________________ ADDRESS: ___________________________ APT. _____ CITY_____________________ ZIP: _______ Cell Phone: ____________________ Email: _________________@_____________________________ ** PLEASE CONTACT THE SCHOOL IF YOU NEED ASSISTANCE COMPLETING THIS FORM. ** I UNDERSTAND THAT MY SIGNATURE INDICATES MY DESIRE TO ENTER MY CHILD INTO THE LOTTERY. PARENT SIGNATURE: __________________________________________ DATE: _________________________ Our applications and waitlist do not roll over. If you applied last year, you must apply again this year.