Philadelphia E & T  Application
Application Process is Open From December 1, 2015 through January 31, 2016. Lottery will be held February 1, 2016 at 10.

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Section A: Student & Parent/Guardian Information
STUDENT ID NUMBER (if applicable):
Student Last Name *
Student First Name *
Student Middle Initial
Current Address *
City *
State *
Zip Code *
Date of Birth *
Gender (Optional)
Parent/Guardian Last Name *
Parent/Guardian First Name *
Relationship to Student *
Parent,Grandparent, Legal Guardian, etc.
Do you have the legal right to enroll this child in school? *
Required
Preferred Contact Number *
Secondary Contact Number
Email Address *
Current Grade Level *
Where did you hear about the school?
Section B: School Choice Information
Name of Charter School You Wish to Attend *
Grade Applying To *
Section C: Sibling Information (If Applicable)
 SIBLING #1
Sibling #1 Last Name
Sibling #1 First Name
Sibling #1 Last Name Date of Birth
School Sibling #1 Currently Attends
Sibling #2
Sibling #2 Last Name
Sibling #2 First Name
Sibling #2 Date of Birth
School Sibling #2 Currently Attends
Sibling #3
Sibling #3 Last Name
Sibling #2 First Name
Sibling #2 Date of Birth
School Sibling #3 Currently Attends
Section D: Parent/Guardian Signature
IMPORTANT: By Signing this form, you indicate that all information provided is accurate. If any of the information that you have provided changes after turning in this form, please submit an amended form prior to the school's deadline. Check with the charter school you wish to apply to for application deadlines. YOU MUST SUBMIT THIS FORM TO THE CHARTER SCHOOL YOU WISH TO ATTEND.

Parent/Guardian Signature (Printed Name Acts as Signature) *
Today's Date
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Internal Use Only
Received By:
Date Received
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