Student Application for 2010-2011

** indicates required field


STUDENT INFORMATION: (Must be 5 years old on or before Sept. 1, 2010)

**Student First Name: **Student Last Name:

**Gender: Select Gender: Female Male

**Age: Select Age: 4 5 6 7 8 9 10 11 12 13 14 15

**Date of Birth: / / (mm/dd/yyyy)

Social Security Number: xxx - xx - (Last 4 digits only)



SCHOOL INFORMATION:

**Current School District:

**Current School:

**Type of School: Select School Type: Public Private Charter Catholic Other

**Current Grade: Select Current Grade: K 1 2 3 4 5 6 7 8 N/A

**Grade Applying: Select Grade Applying: K 1 2 3 4 5 6 7 8 N/A





Does your child have an I.E.P?
Copy of student's Current I.E.P.
If Student was ever in a Special Education Program. If so, what was the student’s exceptionality?




SIBLING INFORMATION:

**I have siblings to list

Sibling 1:   Name   Age 4 5 6 7 8 9 10 11 12 13 14 15   Grade Select Grade: K 1 2 3 4 5 6 7 8 Entering K Next Year

Sibling 2:   Name   Age 4 5 6 7 8 9 10 11 12 13 14 15   Grade Select Grade: K 1 2 3 4 5 6 7 8 Entering K Next Year

Sibling 3:   Name   Age 4 5 6 7 8 9 10 11 12 13 14 15   Grade Select Grade: K 1 2 3 4 5 6 7 8 Entering K Next Year





PARENT/LEGAL GUARDIAN INFORMATION:

**Parent/Guardian Info: Select One: Mother Father Both Parents Guardian Foster Parent Other Relative

If lives with legal guardian, explain relationship to child:



**Parent/Guardian 1 Name:

**Parent/Guardian 1 Street Address:

**Parent/Guardian 1 City: **State: **Zip:

**Parent/Guardian 1 Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 1 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 1 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 1 Email:


**Parent/Guardian 2 Name:

**Parent/Guardian 2 Street Address:

**Parent/Guardian 2 City: **State: **Zip:

**Parent/Guardian 2 Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Alt Phone: - - (xxx-xxx-xxxx)

Parent/Guardian 2 Email:



**Accept Terms:

   I am a resident of Philadelphia, Pennsylvania

   I am applying for my child’s admission to First Philadelphia CS for Literacy. I understand
   that completing the application is part of the admissions process

   I certify that all information on this form is true and correct




I intend to enroll my child in First Philadelphia Charter School for Literacy for the 2010-2011 school year. I agree that inserting my name below and clicking submit constitutes a legal, binding signature.

Parent/Legal Guardian Date: 03/16/2010

APPLICATION DEADLINE:
FRIDAY, FEBRUARY 26TH, 2010 AT 5:00 PM
(NO EXCEPTIONS)