7/29/2019 Green Dot New York (now University Prep Charter High School) Application

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Green Dot New York Charter School**

2013-2014 Application for Entering 9th

Grade Students

Green Dot New York Charter School, founded in partnership with the United Federation ofTeachers, is now accepting student applications. This public high school is providing acomprehensive college-preparatory education.

Located on the fourth floor of600 St. Anns Avenue Bronx, NY 10455 (in the IS 162 Building), theschool will accept 110 9th grade students for the 2013-2014 school year. Current 8th grade studentsmay apply. STUDENTS SHOULD APPLY TO GREEN DOT NEW YORK CHARTER SCHOOL IF THEYWISH TO ATTEND GREEN DOT NEW YORK CHARTER SCHOOL RATHER THAN A DEPARTMENT OF

EDUCATION HIGH SCHOOL.

Application Deadline: April 1, 2013

Mail or Deliver Applications to:Green Dot New York Charter SchoolAttn: Student Application600 St. Anns AvenueFourth FloorBronx, NY 10455

Lottery: If the number of applications exceeds capacity, students will be selected by lottery afterthe due date of the application. Preference is given to students residing in Community SchooDistrict #7. Students not accepted for admission will be placed on a waitlist in the orderdetermined by the lottery. The lottery will be on April 2, 2013 at the school at 5:30pm.

Enrollment: All accepted students must complete the schools enrollment process. Failure tocomplete this process may forfeit acceptance to the school. Students must also complete ourSummer Bridge program in July and August. Among required enrollment forms, families mustpresent documentation that their child has received all vaccinations.

Green Dot New York Charter School does not discriminate against any student on the basis of race,

ethnicity, national origin, gender, or disability or for any other basis that would be unlawful for apublic school.

For additional information, please call 718-292-6543 or 718-585-0560 between 8:30am and4pm or write toakapadia@greendotny.orgor visit www.greendot.org/newyork.____________________________________________________________________________________________

**Please note that the schools name will change during the 2012-2013 school year.

mailto:akapadia@greendotny.orgmailto:akapadia@greendotny.orgmailto:akapadia@greendotny.orghttp://www.greendot.org/http://www.greendot.org/mailto:akapadia@greendotny.org

7/29/2019 Green Dot New York (now University Prep Charter High School) Application

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Green Dot New York Charter School

Application to the 9th Grade for the 2013-2014 School Year(Please complete one application per child) *denotes required

STUDENT INFORMATION

*STUDENTS NAME: _________________________________________________________________________________

*STUDENTS DATE OF BIRTH: _________________________________ *STUDENTS GENDER (CIRCLE ONE): MALE FEMALE

*CURRENT SCHOOL: ________________________________________________________________________________

*CURRENT SCHOOL ADDRESS: ________________________________________________________________________

PARENTS/GUARDIANS INFORMATION

*PARENTS/GUARDIANS NAMES: ______________________________________________________________________

*RELATIONSHIP TO STUDENT: ________________________________________________________________________

*ADDRESS: ___________________________________________________________________________________(STREET) (APT.)

___________________________________________________________________________________(CITY) (ZIP CODE)

*HOME TELEPHONE: __________________________________ WORK TELEPHONE: __________________________________

*MOBILE TELEPHONE: _________________________________ EMAIL: ____________________________________________

ADDITIONAL INFORMATION

*DATE OF APPLICATION (TODAYS DATE):_______________________________________________________________

*NAME OF SIBLINGS ALSO APPLYING TO OR ATTENDING THE GREEN DOT NEW YORK CHARTER SCHOOL:

_________________________________________________________________________________________________

OPTIONALSTUDENT IS IN SPECIAL EDUCATION OR HAS AN IEP (CIRCLE ONE): YES NO

OPTIONALSTUDENT IS IN ENGLISH AS A SECOND LANGUAGE CLASSES OR BILINGUAL CLASSES (CIRCLE ONE): YES NO

I have read and understand the terms of this application, including the requirement of Summer Bridge.

___________________________________________________________*PARENT/GUARDIANS SIGNATURE

Non-Discrimination Statement:A charter school shall not discriminate against or limit the admission of any student on any unlawfulbasis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude,

athletic ability, race, creed, national origin, religion or ancestry. A school may not require any action by a student or family (such as

an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an

application for admission to that school.

FOR OFFICIAL USE ONLY

RECEIVED ON: _______ RECEIVED BY: _______ LOTTERY NUMBER: _______ OF _______