Application English Download Word File

Application English

Section A:


Applicable School Year:


Name of Charter School:


Contact Information for Charter School:

677 East 141st Street, Room 201

Bronx, NY 10454

Phone: (718) 585-4215

Fax: (718) 585-4837



Application Deadline:

Friday, April 1st , 2016 (applications must be in the main office by 5pm – in person, emailed, faxed, or mailed)

Lottery Date and Location:

Thursday, April 7th , 2016 at 5:00 p.m. in the school auditorium

Directions for Submission of Applications:






Please mail or fax your application to the address/fax number provided above (718-585-4837), bring your application to our office (Room 201) in person, or scan and email it to ( Academic Leadership Charter School which is located within the PS 65 building, also called “Mother Hale Academy”, is located at 677 East 141st and Cypress Avenue, Bronx, N. Y. 10454.



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, national origin, 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.


However, Academic Leadership Charter School provides an academic program specifically designed for, in order of preference, siblings of students who currently attend ALCS, residents of district 7, students at-risk of academic failure under the NYC DOE No Child Left Behind choice transfer program, and students who do not live in District 7 and who are entitled to free and reduced lunch. These preferences have been approved by the school’s authorizer and are permissible.


Section B: To be completed by Applicant


Note: A separate application must be completed and submitted for each child applying for admission.




Applicant/ Student Information:                                       Write Your Answers in the Boxes Below

1.* Name (First,   Last):



2.* Date of Birth (MM/DD/YYYY):



3.* Gender (circle one):

Male / Female

4.* Home Address (street address, city, state, zip code):





5.* School District (or New York City Community School District), if known:


6.* Grade Applying for (Pre-K, K, 1, 2, 3, 4, 5, 6, 7, 8):


7.* Does the applicant student have a sibling(s) who is currently enrolled in this charter school? (circle one). If yes, list at least one sibling’s name, current grade and date of birth.

Yes / No


Parent/Guardian Information:

                                                                                    Write Your Answers in the Boxes Below

1.* Name (First, Last):



2.* Relationship to Student:



3. Home Address (street address, city, state, zip code):




4. * Phone Number(s), if available:




5. Email Address




Parent/Guardian Signature: ______________________________ Date: ___________________


* 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.