EATON 2016/2017

YEAR-ROUND LOTTERY APPLICATION New Hanover County Schools

KINDERGARTEN PROGRAM Student Support Services

6410 Carolina Beach Road

Wilmington, NC 28412

Request for EATON year-round School for
Last Name / First / Middle

KINDERGARTEN Grade student will be in when assignment takes place

Address:
Street / City / State / lZip / Home Phone / Work Phone
STUDENT ID # / DOB / AGE / RACE
MALE / Assigned School District 2016/17 / Pre-School Attended 2015/16
FEMALE

LEGAL PARENT/GUARDIAN:

1. Relationship / 2. Relationship
Last Name / Last Name
First Name / First Name

Lives with student? Yes No Lives with student? Yes No

If no, address: / If no, address:
Email / Email
Workplace: / Occupation: / Workplace: / Occupation:
PHONE Home / Work / Cell / PHONE Home / Work / Cell
lEducational Level (H.S., College, etc) / lEducational Level (H.S., College, etc)
NAME OF SIBLING(S) / 2016/2017 Grade / lPlease check your income range:
Less than 30, 000
30,000-50,00
50,000-75,000
75,000-100,000
*Siblings of rising 6th graders are not considered under sibling privilege criteria and will be placed in the lottery / 100,000-150,000
150,000 or more

Please initial that you have read the statements below.

I certify that the information above is accurate and that I will notify the principal immediately of any change of address.
I understand that if I am not accepted, the application will be valid for ONE SCHOOL YEAR ONLY.
Is your child served by an IEP (Individual Education Plan)? Yes No

PLEASE READ CAREFULLY

I understand that once accepted, this becomes my official school assignment for the 2016-2017 school year. Applications are available at all schools, on our website at www.nhcs.net/forms.htm, Central Office or the Spencer Building. Applicant must be registered for kindergarten at their assigned district school with a complete registration packet between March 1– March 18, 2016, to be included in the initial lottery. Registration packet must include: a Certified copy of Birth Certificate or other options as identified by House Bill #1480, Immunization record and proof of residency. Parents will be notified of the lottery results by mail. If accepted, parents will have 5 days from receipt of the letter to respond, in writing, to the school. No applications will be taken after the day before school begins for year round. (July 18, 2016) THERE ARE NO HARDSHIPS TO YEAR-ROUND SCHOOLS.

I understand all information must be completed in full for application to be processed. l REQUIRED ITEMS FOR WEIGHTED LOTTERY.

Parent Signature / Date

APPLICATIONS MAY BE MAILED OR SUBMITTED DIRECTLY TO STUDENT SUPPORT SERVICES, 6410 CAROLINA BEACH ROAD, WILMINGTON, NC 28412, FAXED TO 910-254-4100, OR SUBMITTED DIRECTLY TO THE SCHOOL BETWEEN

MARCH 1– MARCH 18, 2016. PLEASE USE ONE APPLICATION PER STUDENT.

The form may be submitted by email to or it may be mailed to: Denise Angevine, Enrollment Specialist

6410 Carolina Beach Road

Wilmington, NC 28412

2/23/2016