New York State Charter School Uniform Application Form

New York State Charter School Uniform Application Form
Elmwood Village Charter School
40 Days Park, Buffalo NY 14201
716-886-4581 - ph 716-348-3707 - fax
2015-2016 Lottery Application
Applicable School Year:
Name of Charter School:
Contact Information for Charter
School:
Application Postmarked by:
Lottery Date and Location:
40 Days Park
Buffalo, NY 14201
Directions for Submission of
Applications:
2015-2016
Elmwood Village Charter School
40 Days Park
Buffalo, NY 14201
(716) 886-4581
[email protected]
www.elmwoodvillageschool.org
March 31, 2015
Thursday, April 2, 2015 6pm. The Lottery is open to all
families, applicants will be notified by mail within 2 weeks of
lottery. Results will not be given over the phone.
Applications are available online at
http://www.elmwoodvillageschool.org/adminRegForm.html
or you may stop in the main office between 8am - 4pm M-F to
pick one up or call with your complete name and address and we
will send in the mail. ALL applications must be post marked by
March 31, 2015, to be eligible for the 2015-2016 EVCS Lottery.
Kindergarten students MUST be 5 years old
by December 31st of the year for which you
are applying.
Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any
unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of
achievement or aptitude, athletic ability, race, creed, national origin, religion or ancestry. A school may not require any action by
a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an
applicant to either receive or submit an application for admission to that school.
Elmwood Village Charter School gives preference to siblings of current students &
Buffalo residents.
Elmwood Village Charter School Open House Dates:
Thursday, 1/15/ 2015 - 6 to 7:30 pm & Wednesday, 2/4/ 2015 - 8:30 to 10:30 am
You do not need to make a reservation; you may come to one or both.
Page 1 of 2
A separate application must be completed and submitted for each child applying
for admission. All applications in grades 1st – 8th go directly to a wait list.
Elmwood Village Charter School gives preference to siblings of current students
and Buffalo residents.
Applicant Student Information:
1. Name (Last, First):
____________________________________________
2.Date of Birth (MM/DD/YYYY):
3. Gender (circle one):
Male / Female
4.Home Address (street address, city,
state, zip code):
_____________________________________________
_____________________________________________
5. GRADE APPLYING FOR:
Grade: _____________
Kindergarten students MUST be 5 years old by
December 31st, 2015 to apply.
6. Does the applicant student have a
sibling(s) who is also applying? If
yes, list sibling’s name, and grade
applying for. Yes / No
______________________________________ _____
______________________________________ _____
______________________________________ _____
Parent/Guardian Information:
1. Name (Last, First):
2. Relationship to Student:
3. Address (street address, city, state,
zip code):
_____________________________________________
_____________________________________________
4. Phone Number(s):
5. Email Address(es):
Parent/Guardian Signature: ______________________________
Date: ________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~for office use only~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Student Name: _______________________________Grade: ______ Date received: ______
Page 2 of 2