For Office Use

In/Out Dist_________
Free/Red/Pd________

KIPP Infinity Elementary School

Sibling ____________
Date Received ______
Entered ___________
2010-11 Student Application
Lottery Entry Deadline: Applications must be postmarked by April 8, 2010 @ 5pm
Lottery Date: April 13, 2010 @ 5:30pm at KIPP Infinity Elementary
Notification Letters: Mailed on April 16, 2010

KIPP Infinity Elementary School is a free charter school dedicated to providing students in grades Kindergarten with the academic
and character skills necessary to succeed in the nation’s top colleges and beyond. Children who are five years old before December
rd
31, 2010 are eligible to enroll for the 2010-2011 school year. The school will be located at 625 West 133 Street. Please note that
ALL students are welcome to enter the lottery, regardless of test scores, behavioral history, or academic performance.
Attendance at the lottery is not required and will not affect your child’s chances of entering the school. Students who are selected
will be contacted by phone to enroll. Admission preference will be given in the following order:

1) Brothers/Sisters of current KIPP Infinity students

2) Applicants Eligible for Free or Reduced Lunch and Residing in NYC School Districts 5
3) Applicants Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5
4) Applicants Not Eligible for Free or Reduced Lunch and Residing in NYC School District 5
5) Applicants Not Eligible for Free or Reduced Lunch and Not Residing in NYC School District 5

On the back of this form, applicants are strongly encouraged to submit documentation supporting their free and reduced
lunch eligibility. Completing the back form is strictly voluntary, and all information provided will be used for internal
purposes only. For more information about your community school district, please visit: http://gis.nyc.gov/dcp/at/f1.jsp.

If you are interested in having your child enter into KIPP Infinity Elementary School for the 2010-2011 school year, you must fill out
the information below and submit it to KIPP Infinity in person or by mail by April 8, 2010.
Student Name
What grade is your child in currently?
What school does your child attend?
Student Date of Birth (M/D/Y)
Parent/Guardian Name
Address (include Apt. #)
City, ZIP
Phone Number (Home) (Cell)
E-mail
Name and Grade of Current KIPP brother/sister (if
applicable) (Name) (Grade)
Name and Current Grade of Brother/Sister in
Another 2010-2011 KIPP Lottery (if applicable) (Name) (School) (Grade)
How Did You Hear About Us?

By signing and dating the application below, I am hereby certifying that all information provided is accurate and current. I
understand that all information will be verified and enrollment is subject to confirmation of accuracy of the information provided.

______________________________ ___________________________________
Signature Date
You can return this form by mail or in person to:
Stephanie Adams and Lindsay Fry
rd
625 W 133 . New York, NY 10027

All received applications will be confirmed through the mail. If you do not receive written confirmation before the lottery, please
contact Ms. Fry (917-547-8674 ) lfry@kippnyc.org or Ms. Adams (917-547-8725) sadams@kippnyc.org .