Lottery Enrollment Form

Please provide the following information:

Parent Information
Parent/Guardian first name
Parent/Guardian last name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
Parent/Guardian first name
Parent/Guardian last name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone

Student Information
Student #1
First Name
Last Name
Gender	Male Female Other
Date of Birth	MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Grade for 2024—2025 school year	Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Current School
Student #2
First Name
Last Name
Gender	Male Female Other
Date of Birth	MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Grade for 2024—2025 school year	Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Current School
Student #3
First Name
Last Name
Gender	Male Female Other
Date of Birth	MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Grade for 2024—2025 school year	Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
Current School