Application
Application

Lottery Application

2017-2018

 

Applicant’s Full Name   

Preferred Name or Nickname   

Date of Birth  What grade will the applicant be entering in 2017?     

_________________________________________________________________________________________ 

Family Information

Mother/Guardian’s Name

                                      Title: (Mr., Mrs. Etc.)        First                            MI                   Last

 

Address City & Zip Code

 

Home Phone   Cell Phone

 

Email address

 

Place of Employment:Business Phone

 

 

Father/Guardian’s Name

                  Title: (Mr., Mrs. Etc.)           First                            MI                   Last


Address City & Zip Code

Home Phone Cell Phone

 

Email address

 

Place of Employment:BusinessPhone

           

Please list the names and ages of other children living in the home:

Name Age

Attend(ed) GPA?  Y/N   If “Yes”, what years?

 

Name Age

Attend(ed) GPA?  Y/N   If “Yes”, what years

 

Name Age

Attend(ed) GPA?  Y/N   If “Yes”, what years?



Security Measure