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2015-2016 Rhode Island Public Charter School Lottery Application

Student Information
Last Name*
First Name*
Middle Initial
Street Address*
Zip Code*
Date of Birth*M  D  Y  
District Residency*
Grade Applying for* 9th    10th    11th    12th   
Parent/Guardian Information
Relation to the Child*
Relation to the Child
Additional Information
Does the above applicant have a brother or sister currently enrolled in the school?* Yes    No   
If yes, please provide the brother or sister’s name:
Is another brother or sister also applying on a separate form?* Yes    No   
If yes, please provide the brother or sister’s name:
Is the above applicant the child of a school founder?* Yes    No   
If yes, please provide the founder’s name:
I affirm that the information contained in this application is, to my knowledge, completely true.
Parent/Guardian Signature*
Date*M  D  Y  
I agree that my child’s school records may be used for studies on the effectiveness of public charter schools. If the studies are publicized, only group data, not student level data, will be reported. Sensitive student information will remain confidential under state and federal law.* Yes    No   


Note: Checking “No” will NOT affect your child’s chances for admission.

Please complete this application form no later than February 27, 2015.
If you have any questions with this form, call 401-397-8600, fax 401-397-8700, or e-mail

When you properly submit your application, you will receive an automatic response from the web-site. If you do not, please resubmit your application and/or call the school so that we can assist you. Thank you for your interest in The Greene School.