Golden Door Charter School
It is our expectation that all students will achieve;
no exceptions, no excuses.

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  Golden Door Charter School

Golden Door Charter School
Request to Attend
2017-2018
Only one form per family is required;
please list additional children under siblings.

Student

First / Last Name:

  

Street Address:



City / State / Zip Code:

    

Date of Birth:

 /  / 

Grade Level for 2017-2018 School Year:
PreK-4 applicants must be 4 years old
Kindergartners must be 5 years old
on or before September 30, 2017.


School Attended During Previous School Year:



School Street Address:



School City / State / Zip Code:

    

Reason for Transfer:



Siblings
Please list all siblings from the same household
that you would like to attend The Golden Door Charter School.

Sibling 1 First / Last Name:

  

Sibling 1 Date of Birth / Entering Grade Level:

 /  /   
Sibling 1 Previous School:



Sibling 1 Previous School Street Address:



Sibling 1 Previous School City / State / Zip Code:

    

Sibling 2 First / Last Name:

  

Sibling 2 Date of Birth / Entering Grade Level:

 /  /   
Sibling 2 Previous School:



Sibling 2 Previous School Street Address:



Sibling 2 Previous School City / State / Zip Code:

    

As mandated by our charter, we are able to give preference to siblings in the event that a lottery is required. Please indicate which method you would like children in your household entered into the lottery if this situation arises.

Please enter each child individually. I know that not all are guaranteed acceptance if one or more is chosen through the random selection process.
Please enter all children in my household under one name. I know that either all or none of them will be chosen through the random selection process.

Parents/Guardians

Mother's/Guardian's Full Name:



Mother's/Guardian's Street Address:



Mother's/Guardian's City / State / Zip Code:

    

Mother's/Guardian's Home Phone Number:

    

Mother's/Guardian's Cell Phone Number:

    

Mother's/Guardian's Work Phone Number:

      ext. 

Father's/Guardian's Full Name:



Father's/Guardian's Street Address:



Father's/Guardian's City / State / Zip Code:

    

Father's/Guardian's Home Phone Number:

    

Father's/Guardian's Cell Phone Number:

    

Father's/Guardian's Work Phone Number:

      ext. 

Acceptance Procedure - Lottery Notice

Due to limited availability in The Golden Door Charter School, all Request To Attend forms are put into a lottery selection process. DEPENDING on the number of seats that MAY or MAY NOT be available in any particular grade, your child may or may not be placed. For example: if your child has applied for a seat in the 2nd grade and he/she is selected number 1 in the drawing, IF there is a seat available, then he/she may be placed. If a seat is NOT available and he/she is selected number 1 in the drawing, he/she will NOT be placed until and if a seat becomes available. Your child will remain on the waiting list until the following year at which time the waiting list DOES NOT rollover, you MUST complete another Request To Attend the following year.

Name:



Email Address:
If you provide an email address,
a copy of this form will be sent to you.




Date:

 /  / 

 By checking this box, I am electronically providing a signature and certifying that the information entered above is correct to the best of my knowledge.



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Administrators