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Student Information

First Name *

Last Name *

Date of Birth *

What grade will your child be entering this fall? * What grade will your child be entering this fall?

Home Address Information

Street Address *

Apartment, Unit, Building Number

City *

State *

Zip Code *

Is the mailing address the same as the home address? *

Yes

No

Mailing Address Information

Street Mailing Address *

Mailing Apartment, Unit, Building Number *

Mailing City *

Mailing State *

Mailing Zip Code *

What is the school district where the student lives?

What school did your child previously attend?

What is the city and state of your child's previous school?

If your child attended a school previously, what type was it?

Public

Private

Parochial

Home School

Parent/Guardian Information

Parent/Guardian First Name *

Parent/Guardian Last Name *

Relationship *

Email

Primary Number *

Work Number

Mobile Number

Would you like to provide second parent/guardian information (optional)?

Yes

No

Second Parent/Guardian Information

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Second Guardian's Relationship

Second Guardian's Email

Second Guardian's Primary Number

Second Guardian's Work Number

Second Guardian's Mobile Number

Does your child have any siblings attending or applying to Riverhead Charter School?

Yes

No

Sibling Information

If your child has any siblings attending or applying to Riverhead Charter School please enter their information below. If not please continue to the next section.

NOTE: You must fill out a separate application for each child applying for admission.

Name of brother or sister currently attending or applying

Grade for Fall? Grade for Fall?

Name of second brother or sister currently attending or applying

Second Sibling Grade for Fall?

Name of third brother or sister currently attending or applying

Third Sibling Grade for Fall? Third Sibling Grade for Fall?

Additional Information

The information requested below will assist the school in identifying data for demographic purposes and will NOT be used for admission decisions.

Gender

Male

Female

Ethnic Background

Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, gender, national origin, religion or ancestry. A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an application for admission to that school.

How did you hear about us? *

Required Documentation

All file uploads must be in one of the following formats: PDF, JPEG, GIF, DOC or DOCX

Proof of Residency *

Maximum file size: 2MB

Birth Certificate *

Maximum file size: 2MB

Parent/Guardian ID *

Maximum file size: 2MB

reCAPTCHA

Application Instructions:

Student Information

Home Address Information

Mailing Address Information

Parent/Guardian Information

Second Parent/Guardian Information

Does your child have any siblings attending or applying to Riverhead Charter School?

Sibling Information

Additional Information

Required Documentation