Lottery Application Form 2021-2022

First Day of School for the 2021 - 2022 Year is August 9th, 2021

Name*

First NameLast Name

Grade applying for 2021-2022 school year*

Date*

Date

Gender*

Student Ethnicity

Student's Home Language*

Student's Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student's Home Address, if different from Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Is there a sibling currently attending Sugar Creek? If so, please fill out the information below.

Sibling's Name and Current Grade at Sugar Creek Charter School

Sibling Information for New Families

If you are applying for more than one student, you MUST fill out THIS SECTION and an APPLICATION for each child.

Name and Grade of Siblings Applying for SCCS for 2021-2022

Mother/Guardian Name*

First NameLast Name

Mother/Guardian Phone (Home/Work)*

Please enter a valid phone number.

Mother/Guardian Phone (Cell)

Please enter a valid phone number.

Mother/Guardian Email*

example@example.com

Father/Guardian Name*

First NameLast Name

Father/Guardian Phone (Home/Work)*

Please enter a valid phone number.

Father/Guardian Phone (Cell)

Please enter a valid phone number.

Father/Guardian Email*

example@example.com

Emergency Contacts: Please List 3 Emergency contacts including relationship to student and all phone number(s)*

What school does your child currently attend?*

School Name, City, and Child's Grade

Please list all previous schools your child has attended since Kindergarten

School name, City, and Child's Grade

Weighted Lottery

For the 2021-2022 school year, Sugar Creek Charter School will have 20 weighted lottery admissions slots for students who meet one of the following

criteria: 1. Qualify for free or reduced lunch 2. Speak a language other than English in their home 3. Identified as participating in the Exceptional Children's Program (has an IEP) in the weighted lottery is optional. If you choose to participate in the weighted lottery and are not selected, you will automatically be entered into the traditional lottery.

I would like to enter my child in the weighted lottery in the following catagory (choose all that apply). I understand if my student is selected for a weighted lottery spot, I will be required to submit documentation to support the designation.

Qualify for Free or Reduced LunchSpeak a Language other than English in the HomeParticipates in the Exceptional Children's Program (Has an IEP)

If selected, "Speak a Language other than English in the Home," please share what language is spoken in the home:

How did you hear about Sugar Creek Charter School?*

Referred By:

I give Sugar Creek Charter School permission to text me regarding my application.*

Agree

Application Agreement

I understand that by signing this form, I am applying my child for the 2021-2022 academic year. Acceptance is pending space availability.

Registration Agreement I understand that by signing this form I am applying for enrollment for my child for the academic year 2021-2022. Acceptance is pending space availability. If your child’s application is not pulled this year you will have to fill out a new application for the upcoming school. The first day of the 2021 - 2022 academic year is AUGUST 9, 2021.

Agree

Signature

Signature of Parent/Guardian (Please Type Full Name)