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Ivy Bound Academy - Northridge
2021-2022 Lottery Application: For students entering grades 5 to 8 only
schoolid
parent_relationship
preferred_contact
Please Select
phone
email
either
leadid
source
Academic School Year
*
Please Select
2021-2022
Student Information
Student's Name
*
Legal First Name
Legal Middle Name (Optional)
Legal Last Name
Grade Applying For
*
Please Select
5
6
7
8
Student's Date of Birth
*
-
Month
-
Day
Year
Student's Resident Address
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
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Next
Sibling Priority Information
Does this student have a sibling currently attending Ivy Bound Northridge?
Yes
No
Are you submitting additional applications for siblings?
Yes
No
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Next
Parent Guardian Information
Parent/Guardian 1
Name
*
First Name
Last Name
Email
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Relationship to the applicant:
*
Parent
Legal Guardian
Other
Parent/Guardian 2
Guardian 2 Name
First Name
Last Name
Guardian 2 Email
example@example.com
Guardian 2 Primary Phone Number
Please enter a valid phone number.
Guardian 2 Relationship to the applicant:
Parent
Legal Guardian
Other
How did you hear about us?
Please Select
Social Media
Website
Parks & Rec
Library
Event
Friend
Parent/Legal Guardian Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: