Independence Charter School West
LOTTERY APPLICATION 2016-17 SCHOOL YEAR
  • Thank you for your interest in Independence Charter School West. To apply for a student entering grades K-3, please fill out this form and submit no later than February 1. Submit one form for each child. A public lottery will take place February 16th in order to determine admission.
  • Student Information

  • Street Address (no PO Boxes), City
  • / /
  • *Note that all incoming Kindergarten students must be 5 years old by September 1, 2016. No exceptions
  • If "Other" please specify below
  • Family Information

    *Please list full name of a parent/guardian with whom child lives during the school year.
  • Please print clearly
  • - -
  • Please print clearly
  • - -
  • Name of person completing the form.
  • / /
    Date of form completion.
  • Confirmation will be emailed to this address.
  • Independence Charter School-West is a tuition-free pubic school. Admission, the provision of services, and referrals of students shall be made without regard to race, color, religious creed, disability, sexual orientation and gender identity, ancestry, national origin (including limited English proficiency), or age.