Application for Admission 2016/17 / Aplicacion Para Admisión 2016

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Polaris Charter Academy
Attn: Michelle Navarre
620 North Sawyer
Chicago, IL 60624
Where Learning Has No Boundaries…
Application for Admission 2016/17 / Aplicacion Para Admisión 2016/17
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The PCA lottery will take place at Polaris on Wednesday, March 16th at 9:00 a.m.
If your family is new to Polaris Charter Academy, only complete Part A of this
application.
If you have one or more children already attending Polaris Charter Academy, complete
Parts A and B of this application.
PART A:
(1) Student Information/ Información del Estudiante
Student’s Legal Name/ Nombre del Estudiante:
_________________________________________________________________________________________________________
First/ Nombre
Middle/ Segundo nombre
Last/ Apellido
Birth Date/ Fecha de Nacimiento:
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Female/ Mujer
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Month/ Mes _________
Day/ Dia _________
Year/ Ano ________
Male/ Hombre
Current Grade Level/ Grado Actual ______________
Grade level for Aug. 2016/ Grado a cursar en agosto del 2015 ____________________ (K, 1, 2, 3, 4, 5, 6 , 7, 8)
(2) Family Information/ Informacion de la Familia:
Sibling Information/ Información sobre los hermanos:
Please provide the names of the applicant’s siblings, if any, who are also applying to Polaris Charter
Academy. Please note a separate application must be completed for each child who is applying to
Polaris Charter Academy
1. Sibling Name/ Nombres: _____________________________________________________________________________
Current Grade Level/ Grado Actual ______________
Grade level for Aug. 2016/ Grado a cursar en agosto del 2015 ___________________ (K, 1, 2, 3, 4, 5, 6, 7, 8)
2. Sibling Name/ Nombres: ______________________________________________________________________________
Current Grade Level/ Grado Actual ______________
Grade level for Aug. 2016/ Grado a cursar en agosto del 2015 __________________ (K, 1, 2, 3, 4, 5, 6, 7, 8)
(please complete back)
(3) Parent Information/ Información de los Padres
Relationship/Parentesco ________________________________________________________________________________
Full Name/ Nombre completo ____________________________________________________________________________
First/ Nombre
Middle/ Segundo Nombr
Last/ Apellido
Home Address/ Dirección _______________________________________________________________________________
City/ Ciudad ________________________ State/ Estado _________ Zip Code/ Código ___________________________
Home phone/Teléfono ________________________Cell phone/ Celular _______________________________________
Email __________________________________________________________________________________________________
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__________________________________________________________
Parent/Legal Guardian Signature/ Firma de Padres/Guardian
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Date/ Fecha
PART B:
Name of sibling who already attends Polaris Charter Academy
______________________________________________________________________________________________________
Current Grade Level ____________________
Current Room Number ______________________________