STUDENT ADDRESS:
Street Name & Number
Apt# City State Zipcode
Phone Number Date of Birth
Parent/Guardian Information
Who has the authority to apply for this child to attent Green Tech High Carter School?
Mother/Stepmother & Father/Stepfather Mother/Stepmother Only Father/Stepfather Only Legal Guardian(s)
LEGAL GUARDIAN (S): First Middle Last
First Middle Last
ADDRESS:
Phone: Home Cell
Work
Email
Special Needs Information (voluntary, not required)
Has this student ever been evaluated to determine a need for any type of special education services? (Responding to this question is voluntary and will not affect admissions in any way.)
YES, this student has been evaluated. Please complete the following:
Evaluation was provided by: CSE Pediatrician Elementary School Other
Services, if any, that were recom:mended:
NO, this student has never been evaluated.
Sibling Information (voluntary, not required)
List the name birth date, gender and September 2009 grade level of siblings of the student applying to Green Tech High Charter School (Responding to this question is voluntary and will not affect admissions in any way):
Name Date of Birth Grade
Name
Date of Birth Grade
Important Information for Admission: Upon admission, families must provide verification of residency, a copy of the student's prior year academic record, birth certificate and immunization record. In addition, student registration forms, lunch program applications and transportation forms must be completed.
APPLICATION DEADLINE: April 1, 2009 5:30 p.m.
