KIPP Reach College Preparatory                                                           Pre-Enrollment Application
All Pre-Enrollment Applications received after 4:00pm, on Monday, February 15, 2016 will be placed on the waiting list for KIPP College Preparatory accordingly. You may proceed in completing your pre application form knowing your student will be placed on waiting list.                                                                                                                  
                                                                                                                                                                                                                                Please complete 1 form per child you wish to enroll.
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Student  Information
Student First Name *
Student Last Name *
Street Address *
City *
State *
Zip Code *
Student Date of Birth *
MM
/
DD
/
YYYY
Current Grade as of Today *
Current School *
Current School Telephone Number
Parent Information
Parent/Guardian First Name *
Parent/Guardian Last Name *
Street Address (if different from above)
City
State
Zip Code
Home Telephone Number
Work Telephone Number
Cell Phone Number *
Spouse/Other Guardian/Non-Custodial Parent Information
First Name
Last Name
Relationship to Student
Home Phone Number
Work Phone Number
Cell Phone Number
Recruitment Information
Does the student applying have a sibling who is attending or graduated from KIPP Reach? *
Name of KIPP Reach Sibling
Sibling's Current Grade or Year Graduated
Do you know another student who might be interested in KIPP Reach College Prep? What is the student's name and grade?
Parent's Name
Phone Number
Please read the following statement:   I understand that as part of KIPP Reach College Preparatory’s commitment to continual improvement, KIPP Reach College Preparatory is involved in studies of student outcomes. In submitting this application, I grant permission for KIPP Reach College Preparatory or its research partner, Mathematica Policy Research, to request the school records of the student for whom I am submitting this application, including such information as my child's attendance, test scores, or other academic outcomes, for the duration of the study. I further understand that this information may be used for studies of KIPP Reach College Preparatory and that all student-level information will remain confidential as required by the Family Educational Rights and Privacy Act (FERPA). My decision whether or not to participate in the study will have no impact on my child’s likelihood of admission to KIPP Reach College Preparatory. Further, there are no discernible risks to participating in the study and while there are no direct benefits to myself or my child, KIPP and society at large may benefit from the increased knowledge about potential KIPP student achievement and parental satisfaction. If you have any questions about the study or your child’s participation, please contact Lisbeth Goble at Mathematica’s toll-free number, 1-877- 523-4651. For questions about your rights as a research participant, or if you feel that you have been harmed in any way as a result of study participation, please contact Margo Campbell at Public/Private Venture’s IRB at toll-free 1-800-755-4778 x4446. *
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