Lottery Application Form

for admission to The Elysian Charter School

301 Garden Street, Hoboken, NJ   07030, tel:  (201) 876-0102     

fax: (201) 876-9576    website:  ecsnj.org   email:  enrollment@ecsnj.org

 

Application for January 25 Enrollment Lottery for September 2008 Admission (K-8)

 

 

Child’s full name: _______________________________________________________________________                                                                        

 

Date of birth:  ________________________  Grade applying for _____________  Sex:  M  F  (Circle one)

 

 

Current School:_________________________________________________ Current grade_______________

 

Name of 1st parent or legal guardian:

 

_______________________________________________________________________________________

First                                                                                        Last

 

 

__________________________________________________________________ NJ _____________________

Home address:                                                    Apt.#             City                                                                           Zip

          

 

Home phone:__________________  Work phone:__________________ Cell phone:___________________

 

Name of 2nd parent or legal guardian:

 

_______________________________________________________________________________________

First                                                                                        Last

 

 

________________________________________________________________________ NJ__________________

Home  address:                                                       Apt.#                                   City                                                         Zip

 

 

Home phone:_____________­­­­­­­­_______  Work phone:______­­­­­­_______________ Cell phone:_____________________

 

 

Please list any siblings who are also applying to Elysian Charter School for admission in 2007-8:

 

Name: _______________________________________________________    Current Grade ________________

 

 

Name: _______________________________________________________    Current Grade ________________

 

 

Please list siblings already attending Elysian Charter or family members who work there:

 

 

Name(s): _______________________________________________________________________________   

 

 

If Elysian receives more applications than there are openings in a specific grade, a lottery will be held on Friday, January 25, 2007.  If you do not receive a lottery number by January 21, 2007, please contact Lynne Shapiro at Elysian Charter.    As well, contact Lynne to arrange a tour or if you have any questions regarding Elysian’s admissions process, 201 876-0102, extension 12 or by e-,mail at enrollment@ecsnj.org.

 

 

Mail or fax this form to:  Lynne, Shapiro, Elysian Charter School, 301 Garden St., Hoboken, NJ 07030,

fax (201) 876-9576

 

____________________________________________   __________________________________

Signature                                                                                                                Date