8/14/2019 KIPP NYC Elementary - Harlem - 2010-11 Student Lottery Application

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For Office Use

In/Out Dist_________ Free/Red/Pd________ Sibling ____________ Date Received ______ Entered ___________

K IPP NYC Elem ent ary in Har lem2010 11 Student Application

Lottery Entry Deadline: Applications must be postmarked by April 8, 2010 @ 5pm Lottery Date: April 13, 2010 @ 5:30pm at KIPP NYC Elementary School in Harlem

Notification Letters: Mailed on April 16, 2010

KIPP NYC Elementary School in Harlem is a free charter school dedicated to providing students in grades Kindergarten with the academic and character skills necessary to succeed in the nations top colleges and beyond. Children who are five years old before December 31, 2010 are eligible to enroll for the 2010 2011 school year. Please note that ALL students are welcome to enter the lottery, regardless of test scores, behavioral history, or academic performance.

Attendance at the lottery is not required and will not affect your childs chances of entering the school. Students who are selected will be contacted by phone to enroll. Admission preference will be given in the following order:

1) Brothers/Sisters of current KIPP STAR OR Infinity students (depending on schools location) 2) Applicants Eligible for Free or Reduced Lunch and Residing in NYC School Districts 5 3) Applicants Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5 4) Applicants Not Eligible for Free or Reduced Lunch and Residing in NYC School District 5 5) Applicants Not Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5

If you are interested in having your child enter into KIPP NYC Elementary School in Harlem for the 2010 2011 school year, you must fill out the information below and submit it to KIPP Infinity in person or by mail by April 8, 2010.

On the back of this form, applicants are strongly encouraged to submit documentation supporting their free and reduced lunch eligibility. Completing the back form is strictly voluntary, and all information provided will be used for internal purposes only. For more information about your community school district, please visit: http://gis.nyc.gov/dcp/at/f1.jsp .

Student NameWhat grade is your chi ld incurrently ?

What school does your child attend?Student Date of Birth (M/D/Y)Parent/Guardian Name Address (include Apt. #)City, ZIPPhone Number (Home) (Cell) E-mailName and Grade of Current KIPP brother/sister (if applicable) (Name) (Grade) Name and Current Grade of Brother/Sister in

Another 2010-2011 KIPP Lottery (if applicable)(Name) (School) (Grade)

How Did You Hear About Us?

By signing and dating the application below, I am hereby certifying that all information provided is accurate and current. I understand that all information will be verified and enrollment is subject to confirmation of accuracy of the information provided.

______________________________ ___________________________________ Signature Date

You can return this form by mail or in person to: Stephanie Adams and Lindsay Fry 625 W 133 rd . New York, NY 10027

All received applications will be confirmed through the mail. If you do not receive written confirmation before the lottery, please contact Ms. Fry (917 547 8674 ) lfry@kippnyc.org or Ms. Adams (917 547 8725) sadams@kippnyc.org .

http://gis.nyc.gov/dcp/at/f1.jspmailto:lfry@kippnyc.orgmailto:sadams@kippnyc.orghttp://gis.nyc.gov/dcp/at/f1.jspmailto:sadams@kippnyc.orgmailto:lfry@kippnyc.org

8/14/2019 KIPP NYC Elementary - Harlem - 2010-11 Student Lottery Application

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