Academy Charter School



Ben Gamla Charter School - North

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2019-2020 Student Application Form

Upon completion of this application, your child will be considered for the 2019-2020 school year registration for:

Ben Gamla Charter School - North

Serving Grades K-6TH

Please fill out one application per student and return

|Ben Gamla Charter School – North | |

|2620 Hollywood Boulevard | |

|Hollywood, FL 33020 | |

|954-342-4064 | |

Student’s Name:

Last Name First Name Middle Initial

Gender: Male Female Grade Level for 2019-2020:

Student’s Date of Birth: Student ID #:

Name of Last School Attended:

Has the student ever attended a public school? Yes No

Name of Parents/Guardians:

Address:

Street City State Zip Code

Home Telephone #: Work Phone #:

Cellular Phone #: Other Phone #:

Email address:

Please include your email address to expedite the notification of your child’s acceptance.

List all school-age siblings to be registered at Ben Gamla Charter School – North:

| | | |2019-2020 |

|Name |Date of Birth |Current School |Grade |

| | | | |

| | | | |

| | | | |

How did you hear about Ben Gamla Charter School - North?

Ben Gamla Charter School - North is a public charter school, open to all eligible students who reside in Broward County, and subject to the preferences provided for in F.S. 1002.33(10)(d) and described therein. 

Following each enrollment period, the parent/guardian will be notified of his/her child’s eligibility status.  All eligible applicants are required to complete and submit a Registration Packet during the designated registration period (printed below) in order to finalize the registration process.  Failure to do so may affect a student’s application status. Submitting a Student Application Form is not a confirmation of registration in the school and does not guarantee enrollment for any grade level or school year.  

All student enrollments shall be subject to a random lottery and to the racial/ethnic balance provisions described in F.S. 1002.33 (7) (a) (8).  The enrollment schedule for the 2019-2020 academic year is listed below:

Ben Gamla Charter School North–2019-2020 Enrollment Dates:

• Reenrollment and Sibling Registration of Current Students: 01/21/2019 – 01/25/2019

• Initial Enrollment Period 01/14/2019 – 01/18/2019

• Second Enrollment Period: 02/21/201-----06/04/2019

– Should seats become available, a lottery will be conducted to fill open seats by random drawing.

• Initial KINDERGARTEN Enrollment Lottery 02/20/ 2019

• Initial Enrollment Lottery Notification: 02/22/2019

• Initial Enrollment Acceptance Due to School by: 03/06/ 2019

• Initial Enrollment Registration Packet Completion Date: 03/15/2019

• Second Enrollment Lottery: 06/05/ 2019

• Second Enrollment Lottery Notification: 06/06/2019

• Second Enrollment Lottery Acceptance Due to School by: 06/10/ 2019

• Second Enrollment Lottery Registration Completion Date: 06/14/2019

Please respond below:

What was the deciding factor for applying for your child to attend this school?

PARENT’S OR LEGAL GUARDIAN’S SIGNATURE DATE

Your privacy is important to us. Ben Gamla Charter School - North will not share, sell, or disclose your personal information to third parties. It will only be used to transmit information pertaining to our organization.

|For School Use Only |

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|Date Received: ________________ Received By: _______________ |

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