Child’s Name (*)


Date of Birth


Gender
Male Female

Grade for Which the Student is Applying (check one)
Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade


Is the child currently attending another school? (if so)

School Name


Current Grade


School Address


School Type
PublicCatholicAnother Religious SchoolPrivate School (not religiously affiliated)


Is a sibling also applying to DREAM Charter School this year? (If yes, a separate application must be completed for each applying sibling.)

His/Her Full Name


How Did You Learn About DREAM Charter School?

Parent/Guardian

1.

Name


Street Address


Apt #


City


Zip Code


Home Phone


Cell Phone


Work Phone


Email


Relationship to Child

2.

Name


Street Address


Apt #


City


Zip Code


Home Phone


Cell Phone


Work Phone


Email


Relationship to Child


I agree that the school records of the student for whom I am submitting this application may be used for studies of this charter school.In these studies, only aggregate outcomes, not individual students’ outcomes, will be reported. (*)

I agree that the above information is true and correct to the best of my knowledge. (*)

APPLICATION INFORMATION

All children residing in New York State are eligible to attend DREAM Charter School.

Children must turn five (5) by December 31, 2012, to be eligible for Kindergarten.

Preference will be given to students residing in New York City’s Community School District 4.

Signed applications must be received by 4:00pm, April 5, 2012, to be eligible for the lottery.

A lottery will be held on April 19, 2012 at 6:00pm in the school auditorium.

Applications received after 4:00pm on April 5, 2011, will be placed on the waiting list in the order in which they were received.

Please mail, fax or bring this application to:

DREAM CHARTER SCHOOL

232 East 103rd Street, New York, NY 10029 TEL 212 722 0232 FAX 212 348 5979 EMAIL info@dreamschoolnyc.org

DREAMSCHOOLNYC.ORG HARLEM RBI’S DREAM CHARTER SCHOOL. MAKING DREAMS REAL.