Student Application

Applicant Details

Applicable School Year:	2015 - 2016
Name of Charter School:	University Preparatory Charter School for Young Men
Contact Information for Charter School:	Joseph Munno (President) 1290 Lake Avenue Rochester, NY 14613 Phone: (585)672-1280 Fax: (585)458-2732 www.upreprochester.org
Application Deadline:	Wednesday, April 1, 2015 @ 3:30pm
Lottery Date and Location:	UPrep Rochester 1290 Lake Avenue Rochester, NY 14613 Wednesday, April 1, 2015 Time: 4:30pm

Applicant Student Information

First Name:	*
Last Name:	*
Gender:	MALE
Date of Birth:	*
Home Address:	*
School District (School Name & Number:
Grade Applying for:	7th 8th 9th 10th 11th 12th *
Does the applicant student have a sibling(s) who is currently enrolled in this charter school?	Yes No *
If yes, list at least one sibling's name, current grade and date of birth.

Parent/Guardian Information

First Name:	*
Last Name:	*
Relationship to applicant:	*
Home Address (street address, city, state, zip code):	*
Home Phone Number:	*
Cell Phone Number:
Email Address:

Signature	*
Date:	*

By typing your full name and dating above, you electronically sign this application.

IMPORTANT TRANSPORTATION REMINDER

Per the decision of the Commissioner of Education, charter school parents must request transportation from their school districts of residence BY NO LATER THAN APRIL 1st 2014.

Please complete the Rochester City School District Transportation Dept. Form along with the School Application.

After acceptance into UPrep Rochester, UPrep reserves the right to place students into the appropriate grade level after a review of the students records and/or transcripts.

Non-Discrimination Statement:A charter school shall not discriminate against any student or limit the admission of any student on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, disability, race, creed, gender, national origin, religion or ancestry or any other ground that would be unlawful if done by a school. 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.