1290 Lake Avenue
Rochester, New York 14613
(585) 672-1280 Office
(585) 458-2732 Fax
www.upreprochester.org
2017-2018
Applicant Student Information
*Name (First, Last ):*Date of Birth (MM/DD/YYYY)
*Gender: / Male
*Home Address (street address, city, state, zip code)
*School District if known:
*Grade Applying for (Circle One): / 7th 8th 9th 10th 11th 12th
*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
Note: A separate application must be completed and submitted for each child applying for admission.
Parent/Guardian Information
*Name (First, Last):*Relationship to Student:
Home Address (street address, city, state, zip code):
*Phone Number(s) if available:
Email Address(es):
Parent/Guardian Signature______Date:______
*The items marked with an asterisk (*) are the only items that may be required to be submitted in order to apply to this charter school. Any items not marked by an (*) are optional. If you choose not to respond to the optional items, that fact alone will not disqualify the applicant from admission to the school.
www.upreprochester.org
Applicable School Year: / 2017-2018Name 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
www.upreprochester.org
Application Deadline: / Monday, April 3, 2017 at 3:30pm
Lottery Date and Location: / UPrep Rochester
1290 Lake Avenue
Rochester, NY 14613
Monday, April 3, 2017
Time: 4:30pm
Directions for Submission of Applications: / Mail, fax, or hand deliver applications to the Main Office of the school at:
1290 Lake Avenue
Rochester, NY 14613
Fax: (585) 458-2732
*IMPORTANT TRANSPORTATION REMINDER: Per a decision of the Commissioner of Education, charter school parents must request transportation from their school districts of residence BY NO LATER THAN APRIL 3rd, 2017.
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 student 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.