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KNOWLEDGE IS POWER PROGRAM
Dist_________
KIPP Academy · 250 East 156th Street Rm. 418 · Bronx, NY 10451
Free/Red/Pd______
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Sibling
2010-11 Student Application
Lottery Entry Deadline: Applications must be postmarked by April 8, 2010 @
5pm
Lottery Date: April 13, 2010 @ 5:30pm at KIPP Academy
Notification Letters: Mailed to all applicants on April 16, 2010

KIPP Academy Charter School is a free middle school dedicated to providing students in grades 5, 6, 7 and
8 with the knowledge, character, and skills necessary to succeed in the nation’s top high schools and
colleges and beyond. We have opened up lottery entry for current 4th through 7th grade students that are
interested in enrolling at KIPP Academy for the 2010-2011 school year. Please note that all students are
welcome to enter the lottery, regardless of test scores, behavioral history, or academic performance.
Attendance at the lottery is not required and will not affect your child’s chances of entering the school.
Notification letters indicating your child’s place in the lottery will be mailed on April 16, 2010. Students
who are selected will be contacted by phone to enroll. Admission preference will be given in the following
order:
1) Brothers/Sisters of current KIPP Academy students
2) Applicants Eligible for Free or Reduced Lunch and Residing in NYC School District 7
3) Applicants Eligible for Free or Reduced Lunch and Not Residing in NYC School District 7
4) Applicants Not Eligible for Free or Reduced Lunch and Residing in NYC School District 7
5) Applicants Not Eligible for Free or Reduced Lunch and Not Residing in NYC School District
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On the back of this form, applicants are strongly encouraged to submit documentation supporting their
free and reduced lunch eligibility. Completing this portion of the form is strictly voluntary, and all
information provided will be used for internal purposes only. Additionally, to obtain more information
about your community school district, please visit: http://gis.nyc.gov/dcp/at/f1.jsp.
If you are interested in having your current 4th-7th grader enter into KIPP Academy for the 2010-2011
school year, you must fill out the information below and submit it to KIPP Academy Middle School in person
or by mail by April 8, 2010.
Student Name
What grade is your child in
currently?
What school does your child
attend?
Student Date of Birth (M/D/Y)
Parent/Guardian Name

Address (include Apt. #)

City, ZIP

Phone Number (Home) (Cell)

E-mail
Name and Grade of Current KIPP
Academy brother/sister (if (Name)
applicable) (Grade)
Name and Current Grade of
Brother/Sister in Another 2010- (Name) (School)
2011 KIPP Lottery (if applicable) (Grade)
How Did You Hear About Us?

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By signing and dating the application below, I am hereby certifying that all information provided is
accurate and current. I understand that all information will be verified and enrollment is subject to
confirmation of accuracy of the information provided.
______________________________
___________________________________
Signature Date
You can return this form by mail or in person to:
Attn: Cecilia Miranda, KIPP Academy Middle School, 250 E. 156th Street, 4rd Floor, New York, NY 10451
Please call Ms. Miranda with any questions at (718)-665-3555 x 2000
All received applications will be confirmed through the mail. If you do not receive written confirmation
before the lottery, please contact Ms. Miranda. Please also note that while we accept applications for each
grade level (5th-8th grade) we have very few spaces available at the 6th, 7th and 8th grade.

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