2018-2019 RHODE ISLAND PUBLIC CHARTER SCHOOL LOTTERY APPLICATION - English Must be 5 on or before September 1st, 2018 to for the Kindergarten school year and All students must reside/Live in Providence to be eligibleStudent InformationLast NameFirst NameMiddle NameDate of Birth (mm/dd/yyyy)*Home AddressStreet, House/Apt #*City*All students must reside/live in the City of ProvidenceState* (Two letter state code _ _ )Zip Code* (5 digit zip code _ _ _ _ _)Grade Selections...Current Grade*Pre-KK1234567891011Confirm Current Grade*Type exactly as it appears in the dropdownGrade Applying To*K123456789101112Confirm Grade Applying To*Type exactly as it appears in the dropdownParent/Guardian InformationParent/Guardian (1) - NameParent/Guardian (1) - PhoneParent/Guardian (1) - Email Parent/Guardian (1) - Relation to the ChildParent/Guardian (2) - NameParent/Guardian (2) - PhoneParent/Guardian (2) - Email Parent/Guardian (2) - Relation to the ChildAdditional InformationDoes the applicant have a brother or sister currently enrolled in this charter school?YesNoIf yes, name of brother/sisterFor sibling applicants: Please scan and email or bring the Birth Certificate off applicant and student who is presently enrolled at the school.Does the applicant have a brother or sister applying to this school on a separate application?YesNoIf yes, name of brother/sisterIs the applicant the child of a school founder, teacher, or staff member at this school?YesNoIf yes, name of founder/teacher/staff memberLegal Information:I affirm that the information contained in this application is, to my knowledge, completely true.Parent /Guardian SignatureToday's Date (mm/dd/yy)I agree that my child’s school records may be used for studies on the effectiveness of public charter schools. If the studies are publicized, only group data, not student level data, will be reported. Sensitive student information will remain confidential under state and federal law.Agreed?YesNoNote: Selecting “No” will NOT affect your child’s chances for admission. Please submit this application no later than February 17, 2018 If you have questions, please contact Attn: Cheryl Galloway (email@example.com) 50 Fillmore St, Providence RI 02908 - 401-272-5094 ext. 106 Note: Under Rhode Island law, a charter school is deemed to be a public school acting under state law and is subject to applicable provisions of federal and state law relating to non-discrimination and affirmative action, including, but not limited to, the: (1) Age Discrimination Act of 1975, 42 U.S.C. § 6101, et seq.; (2) Title VI of the Civil Rights Act of 1964, 42 U.S.C. § 2000d, et seq.; (3) Title IX of the educational amendments of 1972, 20 U.S.C. § 1681, et seq.; (4) Section 794 of Title 29, and part B of the Individuals with Disabilities Education Act, 20 U.S.C. § 1411, et seq.; (5) 42 USC, Sections 1981, 1983 and 1601 et seq.; (6) Section 504 of the Rehabilitation Act of 1973, as amended, 20 USC 794; and (8) Sections 16-38-1, 16-38-1.1, 28-5.1-13, 28-5.1-14 and Chapter 42-87 of the Rhode Island General Laws, as amended.Section Break This iframe contains the logic required to handle Ajax powered Gravity Forms.