Zone Exception/Lottery Application Form - Highland Tech High - Anchorage School District Charter School

Zone Exception/Lottery Application Form
(Use One Form Per Student Applicant)

* = required field

1. Applicant Information

* Program and/or School Requested:
* Student Name:	* Student Number:
* Student’s Birthdate:	* Student Home School:
* Student Gender: M F	* Current Grade:

2. Parent/Guardian Information
(*may be released for “Waiting List Directory”)

* * Parent/Guardian Name (Last, First, Middle):

* * Mailing Address:

* Residence Address: (If different than mailing address)

* * Home Phone:

Work Phone:

* Emergency Phone:

* Parent/Guardian Release: Allow Deny
* Date:

3. Sibling Information

* Does the above applicant have a brother or sister currently in this school? Yes No

If yes, provide sibling name (Last, First, Middle):

* Is there a sibling also applying on a separate application?
Yes No

If yes, provide sibling name (Last, First, Middle):

Sibling Grade Level (if Applicable):

4. Zone exception only

* Reason for exception:
I. Open enrollment (subject to space available)
II. Medical/extenuating circumstances—written justification to be attached to this form.
III. Continuation of current zone exception.

If zone exception approved, the following conditions apply:
1. Appropriate ASAA eligibility rules must be followed
2. Parents are responsible for student transportation.
3. Students must arrive and depart at times designated by the principal.
4. Disciplinary concerns can cause revocation of zone exception.
5. Parent/Guardian Statement
I understand that if no space is currently available for placement of the applicant, this application will be held for inclusion in the next lottery process for the program/school requested. I have been given a copy of the Open Enrollment-Lottery Procedure and a description of the program for which this application is being submitted. I realize, too, that this application does not guarantee admission to the program/school and that the lottery procedure will place the applicant’s name on a wait list for the program/school. I understand that if I wish to enter any other school or program, under the open enrollment policy it is my responsibility to file additional applications at those schools. Any false statement is cause for nullification of the zone exception/lottery selection.

Parent/Guardian Confirmation: (A written signature will be required if this form is accepted)
* Parent/Guardian Name:
* Date:
* Email: