ROCHESTER ACADEMY CHARTER SCHOOL
Online Student Application Form
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  DEAR PARENTS AND APPLICANTS:
  Thank you for your interest in Rochester Academy Charter School. There is no cost to apply or attend Rochester Academy Charter School. Rochester Academy is a free charter public school currently serving students in grades 6-12 and will eventually expand to serve grades K-12. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application.
   
   Applicant's Personal Information
   
      Year Applying: *
  Grade Applying: *
  Last Name: *
  First Name: *
Middle Name:
  Date of Birth: *
  Gender: *
  Street: *
  City: *      State: *      Zip: *
 
Does the student has any documented history of criminal offense or juvenile court adjudication?
if yes, explain:
 
   Applicant's School Information
   
  School District: *
 
   Applicant's Family Information
   
         
  Parent: * If Other: *
  Title:    
  First Name: * Last Name: *
  Street:
  City: State:      Zip:
  Home Phone: * Work Phone:
  Cell Phone: Email: *
         
  Parent: If Other :
  Title:    
  First Name: Last Name:
  Street:
  City: State:      Zip
  Home Phone: Work Phone:
  Cell Phone: Email:
         
 
Does the applicant student have a sibling(s) who is currently enrolled in this charter school? *
  If yes, list at least one sibling’s name, current grade and date of birth: *
         
   How did you hear about Rochester Academy Charter School ?
   
   
       
           
 
Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, gender, national origin, religion or ancestry. A school may not require any action by a student or family (such as an admissions test, interview, essay, attendance at an information session, etc.) in order for an applicant to either receive or submit an application for admission to that school. Declaración de no discriminación: Una escuela charter no discriminará o limitar la admisión de cualquier estudiante en cualquier forma ilegal, en particular sobre la base del origen étnico, origen nacional, sexo, discapacidad, capacidad intelectual, medidas de rendimiento o aptitud, habilidad atlética, raza, credo, sexo , origen nacional, religión o ascendencia. Una escuela no puede requerir acción alguna por un estudiante o de la familia (por ejemplo, una prueba de admisión, la entrevista, el ensayo, la asistencia a una sesión de información, etc) con el fin de que el solicitante sea recibir o presentar una solicitud de admisión a la escuela.

* The items marked with an asterisk (*) are the only items that are required in order to apply. Any items not marked by an (*) are optional. * Los artículos marcados con un asterisco (*) son los únicos elementos que se requieren para aplicar. Cualquier artículo que no estén marcadas con asterisco (*) son opcionales.