In/Out Dist_________
Free/Red/Pd________
Sibling ____________
Date Received ______
Entered ___________
Tier_______________
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 STAR
Notification Letters: Mailed to all applicants on April 16, 2010
KIPP STAR 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 STAR 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 STAR students
2) Applicants Eligible for Free or Reduced Lunch and Residing in NYC School District 5
3) Applicants Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5
4) Applicants Not Eligible for Free or Reduced Lunch and Residing in NYC School District 5
5) Applicants Not Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5
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 STAR for the 2010‐2011 school year, you must fill out the
information below and submit it to KIPP STAR 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 STAR
brother/sister (if applicable) (Name) (Grade)
Name and Current Grade of Brother/Sister in
Another 2010‐2011 KIPP Lottery (if applicable) (Name) (School) (Grade)
How Did You Hear About Us?
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: Beatrice Padilla, KIPP STAR Middle School, 433 W. 123rd Street, 4th Floor, New York, NY 10027
Please call Ms. Padilla with any questions at (212) 991‐2650 x 3001
All received applications will be confirmed through the mail. If you do not receive written confirmation before the lottery, please
contact Ms. Padilla. 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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