NEW STUDENT APPLICATION

Please fill out this application for your child.  In the event there are more applicants than class seats, there will be a random lottery.  This lottery will be held in March.  Students who are not selected in the lottery will be place on a waitlist.  Per our contract with the School Board of Alachua County, students who live within five miles of the school will receive entry preference.

Grade your student would like to enter: ______            When will your student be entering our school?____________

Student’s Name: _______________________________________________________________________________

                                Last                                                                        First                                                        Middle

Date of Birth: _____________________________                                    Student’s Sex:       M            F              (Circle one)

Home Address: ________________________________________________________________________________

                                Number and Street                                                               City, Town                                            Zip

*Proof of address and Identification must be attached before application is considered.

Mailing Address (if different from Home Address): ___________________________________________________

Phone (Day): __________________ Phone (Night):____________________ E-mail address: __________________

List Special Needs of the Student: _________________________________________________________________

Check any of the following that apply:              IEP      504       SPEECH/LANGUAGE THERAPY  OT

 ALLERGIES       OTHER/EXPLAIN: ____________________________________________________________

Parent(s)/Legal Guardian(s) Name: ________________________________________________________________

Do any sibling currently attend this school?  If so, what grade and name ___________________________________

If your child has previously attended school, what school did they attend? __________________________________

_________________________________________________________                                           ______________________

Parent/Legal Guardian Signature                                                                                                       Date

To Be Filled Out Upon Receipt:                                         To Be Filled Out After Lottery:

Date completed application received: ___________              Accepted / Waitlisted             Date: ________________

Office Initials: ________                                                        Office Initials: ___________