New Jersey



New Jersey Initial Charter School Application (SAMPLE)2018-2019130492514795500Student's Name(Last)(First)(Middle)Gender _____ Age _________ Date of Birth ___/____/____ Current Grade _______________ Expected Grade for Next Year ______________What grade is this student applying for in the 2018-2019 school year? _______84772513271500Address(Number / Name of Street)(Apt. #)(City/State)(Zip Code)138112513462000Mailing Address(if different from above) (P.O. Box # or Number/Name of Street) (City/State) (Zip Code)Home Phone # ____________________ Alternate Phone # ________________Family Information43624501905004943475190500576262519050012668251905002085975190500695325190500Check one: Parent Step-parent Legal GuardianCheck one: Parent Step-parent Legal Guardian43910251390650069532513906500Full Name: Full Name: 45529501409700084772514097000Home Phone:Home Phone: 44862751333500084772513335000Work Phone: Work Phone: 43910251352550069532513525500Cell Phone: Cell Phone: 46386751371600095250013716000Email Address: Email Address: Sibling Policy: Preference is given to siblings of enrolled students (N.J.S.A. 18A:36A-8c). Please list any siblings (brothers/sisters) applying for or enrolled at _______________ Charter School this year.41624251143000077152511430000Sibling 1 Name Grade in 2018-19 41624251136650077152511366500Sibling 2 Name Grade in 2018-19 41624251136650077152511366500Sibling 2 Name Grade in 2018-19 3648075153035007620015303500(Signature of Parent/Guardian)(Date) ................
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