Liberty Common School Online Lottery Form

Fill out completely for each student and use the submit button at the bottom to send the completed form to Liberty Common School.

Today's Date:

Student #1:
Date of Birth (month/day/year):
Gender:   Grade:   Year:   Sibling enrolled?:

Student #2:
Date of Birth (month/day/year):
Gender:   Grade:   Year:   Sibling enrolled?:

Student #3:
Date of Birth (month/day/year):
Gender:   Grade:   Year:   Sibling enrolled?:

Student #4:
Date of Birth (month/day/year):
Gender:   Grade:   Year:   Sibling enrolled?:

Home Address:
City:
Zip Code:
Phone Number:
E-mail address:

Ethnic Code:   Asian     Hispanic     Black     American Indian     White    

Is there any other language other than English ever spoken in the home?

Parent(s)' or Guardian's Name(s):
Are either employed by the Federal government?   Yes     No

Father's Business Phone:
Mother's Business Phone:

Student is living with: Mother and Father     Father     Mother     Guardian     Other

Most Recent School(s) Attended:

The following information will remain strictly confidential, and is for statistical purposes only.
It is possible that because of my family income and size, I may be eligible to participate in the National Free and Reduced Lunch Program.
  Yes     No

If you are submitting a student for Kindergarten level, please choose an enrollment option.
 All day only ($300 tuition per month ^*)  
 Half Day Only  
 Either half day or all day  

 ^* Tuition subject to change.

By submitting this form I understand that my child/ren's name(s) are being placed in a Lottery Pool for Liberty Common, and that I will be contacted if an opening is available. My name will remain on the list unless otherwise requested. It is my responsibility to contact the school with any phone or address changes.