» Online Application

Student Application for 2012-2013

Student Name(required)
Home Phone(required)
Street Address(required)
Apartment/Unit
City(required)
State(required)
Zip Code(required)
Grade during 2012-2013 school year
Student Gender(required)
Current School
First Parent/Guardian Information
Name
Does this parent/guardian live with the child mentioned above?
Yes No
Email Address
(e.g. name@example.com)
Home Phone
(e.g. (555) 555-5555)
Cell Phone
(e.g. (555) 555-5555)
Work Phone
(e.g. (555) 555-5555)
Second Parent/Guardian Information
Name
Does this parent/guardian live with the child mentioned above?
Yes No
Email Address
(e.g. name@example.com)
Home Phone
(e.g. (555) 555-5555)
Cell Phone
(e.g. (555) 555-5555)
Work Phone
(e.g. (555) 555-5555)
How did you hear about KIPP Indianapolis College Preparatory?
Do you know of another rising 5th/6th grader who might be interested in KIPP Indianapolis College Preparatory?
Student Name
Parent/Guardian Name
Phone Number
(e.g. (555) 555-5555)
Email Address
(e.g. name@example.com)
Disclaimer and Signature for KIPP Indy
I certify that all the answers given in this enrollment application are true, accurate, and complete. I understand that if my child is enrolled, my having given false or misleading information in any of my application forms, residency forms, or having omitted significant information therefrom, may result in the discharge of my child from the school.
I have read and agree to the above statement (required)
Signature(required)
Date
(e.g. mm/dd/yyyy)(required)