EmailMe Form - ICS-West 2018-19 Kindergarten Application

Select the grade that your child will be entering in September 2018. Incoming kindergarten students must turn five by September 1, 2018 to be eligible for the kindergarten lottery. No exceptions. *

Student Name *

First Middle Last

Type full name exactly as it appears on birth certificate.

Student Street Address *

Philadelphia, PA
Zip Code *

Which Catchment area does the student live? *

Sayre

Bartram

Overbrook

Other

If you are unsure please check school finder on the school districts website at the following link:
https://webapps1.philasd.org/school_finder/

Student Birth Date *

MM / DD / YYYY

If your child currently attends school/preschool, please list the name of current school.

Parent/Guardian #1 Name *

First Last

This parent/guardian must live at the same address as the student.

Parent/Guardian #1 Email *

This email address will receive an email receipt of this application.

Please retype email to confirm

Primary Phone *

### - ### - ####

Parent/Guardian #2 Name (if applicable)

First Last

Parent/Guardian #2 Email

Phone

### - ### - ####

Parent/Guardian #2 Street Address (if not the same as student's)

City, State, Zip

Does this student have siblings in the same household who currently attend ICS-West and will still be enrolled at ICS-West in 2018-2019? *

Yes

No

If yes, list sibling full name(s).

Does this student have siblings in the same household for whom you are also submitting 2018-2019 ICS-West lottery applications? *

Yes

No

If yes, list sibling name(s) and grade(s) they are entering in 2018-2019. Remember that you will need to submit a separate application for each sibling.

Remember that you must submit a separate lottery application for each sibling.

*

By typing my name below, I am confirming that all information on this application is true. I understand that if I have falsified any information on this application, the application will be null and void.

*

I understand that if selected for enrollment, I will be required to submit proof of Philadelphia residency and proof of child’s birthdate.

Your Name *

First Last