Scholar Application 2018–2019 School Year Application Deadline: April 1, 2018 Applications May Also Be Submitted Online at Successacademies.Org/Apply

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Scholar Application 2018–2019 School Year Application Deadline: April 1, 2018 Applications may also be submitted online at SuccessAcademies.org/Apply.

Please read before completing:

. You must be a resident of New York State to apply to any Success Academy school.

. This application is for Success Academy schools only. This application is not affiliated with other New York City charter schools or Department of Education applications.

. Applicants must be entering pre-kindergarten, kindergarten, 1st, 2nd, 3rd or 4th grade.

. Your child must be four years old on or before December 31, 2018 to apply to pre-kindergarten.

. Your child must be five years old on or before December 31, 2018 to apply to kindergarten.

. If applying for more than one child, we strongly recommend only applying to schools that offer all of your children's grades.

. Review carefully before submitting! Answer all questions, as blank fields may result in an unprocessed application.

. While Success Academy schools offer pre-kindergarten through 12th grade, we only accept applications for children entering pre-kindergarten through 4th grade. PAGE 1 OF 4: CONTINUE ON NEXT PAGE

Application Deadline: April 1, 2018

STEP 1: PARENT/GUARDIAN INFORMATION PASO 1: INFORMACIÓN SOBRE EL PADRE, LA MADRE O EL GUARDIÁN LEGAL

RESPONSIBLE ADULT ° (SELECT ONE): Parent/Guardian 1 Parent/Guardian 2 ° The Responsible Adult must be this child's parent or legal guardian with whom the child resides. The Responsible Adult will be the main contact and primary decision maker for information submitted or edited on this application.

PARENT/GUARDIAN 1 PARENT/GUARDIAN 2 (IF APPLICABLE)

Parent/Guardian Full Name * Parent/Guardian Full Name * Relationship to Child * Relationship to Child *

Primary Phone * ( ) - Primary Phone * ( ) - Secondary Phone ( ) - Secondary Phone ( ) - Work Phone ( ) - Work Phone ( ) -

Email Email

STEP 2: CHILD INFORMATION PASO 2: INFORMACIÓN SOBRE EL NIÑO

EACH APPLYING CHILD REQUIRES A SEPARATE APPLICATION. How many children are you applying for?

Child’s First Name* Child’s Last Name*

Child’s Home Address* Apt. Number City* State* Zip* Borough

Date of Birth* Month Day Year Gender* Male Female

Current School Name Not currently enrolled in school

What grade is your child entering next school year (August 2018–June 2019)?*

Pre-kindergarten Kindergarten My child has difficulty with English because another language is spoken at home.◊ Yes No

1st Grade 2nd Grade 3rd Grade 4th Grade My child’s current school has told me he/she is an English Language Learner (ELL).◊ Yes No

◊ We are collecting this information because we give English Language Learners a weighted preference in the Lottery.

PAGE 2 OF 4: CONTINUE ON NEXT PAGE STEP 3: CHOOSE SCHOOL(S)* PASO 3: ELECCIÓN DE LA(S) ESCUELA(S)*

IMPORTANT RANKING I am applying for my child to attend the following Success Academy (SA) school(s): (Check all that apply) INFORMATION Reminder: make sure to only apply your child to schools accepting the grade that he or she is entering.

If you are applying to more than one school, PRE-KINDERGARTEN you may list your school preferences ACCEPTING SCHOOL numerically in the ‘Rank’ box to the right of APPLY RANK SCHOOL GRADES∆ ADDRESS BOROUGH DISTRICT the ‘Apply’ box. If you do not rank your SA Harlem 1 † Pre-K 34 West 118th Street Manhattan 3 schools, they will automatically be ranked by SA Hudson Yards † Pre-K 500 W 41st Street Manhattan 2 proximity to your home (closest to farthest). SA Union Square † Pre-K 40 Irving Place Manhattan 2 Your child will be entered in the lottery SA Washington Heights † Pre-K 701 Fort Washington Avenue Manhattan 6 for ALL schools you’ve applied to, regardless of ranking. Ranking a school at the top SA Cobble Hill † Pre-K 284 Baltic Street Brooklyn 15 or bottom of the list will not increase or SA Fort Greene † Pre-K 101 Park Avenue Brooklyn 13 decrease your chances of acceptance into that school. Ranking is used only to assign ELEMENTARY (KINDERGARTEN – 4TH GRADE) your child to your preferred Success ACCEPTING SCHOOL APPLY RANK SCHOOL GRADES∆ ADDRESS BOROUGH DISTRICT Academy if he or she is accepted to more than one school. SA Bronx 1 K,1,2,3,4 339 Morris Avenue Bronx 7 SA Bronx 2 K,1,2,3,4 450 Saint Paul’s Place Bronx 9 To rank your schools: SA Bronx 4 K,1,2,3,4 885 Bolton Avenue Bronx 8 1. Assign a number to each selected school, SA Bronx 3 K,1,2 968 Cauldwell Avenue Bronx 8 where 1 is your most preferred school. 2. Every selected school must have a number. SA Bed-Stuy 1 K,1,2,3,4 70 Tompkins Avenue Brooklyn 14 3. Do not assign the same number to more SA Bed-Stuy 2 K,1,2,3,4 211 Throop Avenue Brooklyn 14 than one school. SA Bensonhurst K,1,2,3,4 99 Avenue P Brooklyn 21 If accepted at more than one school, we SA Bergen Beach K,1,2,3,4 1420 East 68th Street Brooklyn 22 will only reserve a seat for your child at the SA Cobble Hill K,1,2,3,4 284 Baltic Street Brooklyn 15 school with the better ranking. SA Crown Heights K,1,2,3,4 330 Crown Street Brooklyn 17 SA Fort Greene K,1,2,3,4 101 Park Avenue Brooklyn 13 SA Prospect Heights K,1,2,3,4 801 Park Place Brooklyn 17 SAMPLE SA Williamsburg K,1,2,3,4 183 South 3rd Street Brooklyn 14 SA Bed-Stuy 3 K,1,2,3 787 Lafayette Avenue Brooklyn 16 APPLY RANK SCHOOL SA Bushwick K,1,2,3 139 Menahan Street Brooklyn 32 2 SA Harlem 1

SA Harlem 2 SA Flatbush K,1,2,3 15 Snyder Avenue Brooklyn 17 3 SA Harlem 3 1 SA Harlem 4 SA Harlem 1 K,1,2,3,4 34 West 118th Street Manhattan 3 SA Harlem 2 K,1,2,3,4 144 East 128th Street Manhattan 5 SA Harlem 3 K,1,2,3,4 410 East 100th Street Manhattan 4 SA Harlem 4 K,1,2,3,4 240 West 113th Street Manhattan 3 SA Harlem 5 K,1,2,3,4 301 West 140th Street Manhattan 5 SA Hell’s Kitchen K,1,2,3,4 439 West 49th Street Manhattan 2 SA Union Square K,1,2,3,4 40 Irving Place Manhattan 2 SA Upper West K,1,2,3,4 145 West 84th Street Manhattan 3 SA Washington Heights K,1,2,3,4 701 Fort Washington Avenue Manhattan 6 SA Harlem 6 K,1,2 461 West 131st Street Manhattan 5 SA Hudson Yards K,1,2 500 West 41st Street Manhattan 2

SA Rosedale K,1,2,3,4 147-65 249th Street Queens 29 SA Springfield Gardens K,1,2,3,4 132-55 Ridgedale Street Queens 29

∆ Grades that are currently accepting applications SA Far Rockaway K,1,2,3 10-45 Nameoke Street Queens 27 † Pending government approval SA South Jamaica K,1,2,3 120-27 141st Street Queens 27

PAGE 3 OF 4: FINISH ON BACK PAGE STEP 4: SIBLING INFORMATION A SEPARATE APPLICATION MUST BE COMPLETED AND PASO 4: INFORMACIÓN SOBRE LOS HERMANOS SUBMITTED FOR EACH CHILD APPLYING FOR ADMISSION.

SIBLINGS MUST SHARE AT LEAST ONE PARENT OR LEGAL GUARDIAN IN ORDER TO QUALIFY FOR THE SIBLING PREFERENCE. Enrolled Sibling: Does your child have a sibling who is currently enrolled in a Success Academy school?* No Yes If YES, please complete the following: (You must list your child’s enrolled sibling to be eligible to receive a sibling preference. Preference is subject to verification.)

Enrolled Sibling Attends* Success Academy Grade Entering Next Year* (enter school name above) Sibling’s First Name* Sibling’s Last Name*

Date of Birth* Month Day Year Gender Male Female

Applying Siblings: Does your child have a sibling who is applying to a Success Academy? No Yes If YES, please complete the following:

Sibling’s First Name Sibling’s Last Name

Date of Birth Month Day Year

Grade Entering Next Year Gender Male Female

STEP 5: SIGN AND MAIL PASO 5: FIRMA Y ENVÍO POR CORREO

Admission is determined by a lottery. Admission is not limited based on any factor, but a lottery preference is given to:

. Siblings of currently enrolled and newly accepted children . Children of Success Academy employees . Community School District (CSD) residents

English Language Learners (ELL) receive a weighted preference in the lottery.

There is NO fee to apply to or attend a Success Academy. If you sign below, you are permitting Success Academy Charter Schools to use your child’s school records for data collection and analysis. No personal information is ever disclosed in these studies. Consenting to future studies, or not consenting, does not affect your child’s chances of being admitted. By submitting this application, you are confirming that all of the information you provided is true to the best of your knowledge and understand that admission may be revoked and/or waitlist position(s) forfeited if information provided is inaccurate.

Sign Here Date

MAILING ADDRESS Success Academy Charter Schools Attn: Enrollment 95 Pine Street, Floor 6 New York, NY 10005

EMAIL [email protected] TO LEARN MORE, GO TO WWW.SUCCESSACADEMIES.ORG/APPLY

* The items marked with an asterisk (*) are the only items that may be required in order to apply to this charter school. Any items not marked by an (*) are optional.

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, 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.

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