Green Tech High Charter School

Application for Student Admission: 2012-2013

For help completing this application, please call 518-694-3400
Para un uso en español, llame por favor 518-694-3400.

Green Tech High Charter School is accepting applications for enrollment for ninth grade boys. Enrollment preference is given to students who live in the City of Albany. If the number of applications received exceeds the space available, a random lottery will be held on April 2, 2012 to determine admission to the school.

Please complete the form below. Mandatory fields marked *

How did you hear about Green Tech High Charter School for Boys?
Radio
Newspaper
Door Hanger List neighborhood
Word Of Mouth
Current/Past Student Student Name
Parent of Current/Past Student Parent Name
Internet Search
Billboard
Bus Shelter Ad
Other

Student Information

Student's First Name * : Student's Last Name * :
Street address *:
City *: State *: Zip *:
Phone * :
Date of Birth * : (DD/MM/YYYY)
School Previously Attended * :
Grade Previously Attended * : 8 9 10 11 12
Grade Applying For * : 9 10 11 12

Parent/Guardian Information

Who has the legal authority to apply for this child to attend Green Tech High Charter School? *
Mother/Stepmother & Father/Stepfather Mother/Stepmother only Father/Stepfather only Legal Gaurdian (s)
First Name * : Last Name * :
Street Address * :
City * : State * : Zip * :
Home phone * :
Cell * :
Work * :
Email address * :

Special Needs Information (voluntary, not required)

Has this student ever been evaluated to determine a need for any type of special education services? (Responding to this question is voluntary and will not affect admissions in any way.)
YES, this student has been evaluated. Please complete the following:
Evaluation was provided by: CSE Pediatrician Elementary School Other:
Services if any they recommended:
NO, this student has never been evaluated

Sibling Information (voluntary, not required)

List the name, birth date, gender and September 2012 grade level of siblings of the student applying to Green Tech High Charter School (Responding to this question is voluntary and will not affect admission in any way):

First Name: Last Name: Birth date: Grade:
First Name: Last Name: Birth date: Grade:
First Name: Last Name: Birth date: Grade:

Parent/Guardian Signature I hereby testify that the information provided on this GTH admission application is accurate and current.
Print Name*: Date *: (DD/MM/YYYY)

FOR OFFICE USE ONLY - DO NOT ENTER INFO

Manual Application Date : Submitted By :

Important Information for Admission: Upon admission, families must provide verification of residency, a copy of the student's prior year academic record, birth certificate and immunization record. In addition, student registration forms, lunch program applications and transportation forms must be completed.