Online Student Application Form
English | Espanol

Thank you for your interest in Utica Academy of Science Charter School. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application.

Application Deadline: April 01, 2017. The lottery day for 2017-18 applicants will be on Thursday, April 13, 2017 at 01:00 PM at Utica Academy of Science Charter School (160 School Lane, Frankfort, NY 13340).
   Applicant's Personal Information
      Year Applying: *
  Grade Applying: *
  Last Name: *
  First Name: *
Middle Name:
  Date of Birth: *
  Gender: *
  Street: *
  City: *      State: *      Zip: *
Does the student has any documented history of criminal offense or juvenile court adjudication?
if yes, explain:
   Applicant's School Information
  School District:
   Applicant's Family Information
  Parent: * If Other: *
  First Name: * Last Name: *
  City: State:      Zip:
  Home Phone: * Work Phone:
  Cell Phone: Email: *
  Parent: If Other :
  First Name: Last Name:
  City: State:      Zip
  Home Phone: Work Phone:
  Cell Phone: Email:
Does the applicant student have a sibling(s) who is currently enrolled in this charter school? *
  If yes, list at least one sibling’s name, current grade and date of birth: *
   How did you hear about Utica Academy of Science Charter School ?
Non-Discrimination Statement: A charter school shall not discriminate against or limit the admission of any student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed, gender, national origin, religion or ancestry. 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. Declaración de no discriminación: Una escuela charter no discriminará o limitar la admisión de cualquier estudiante en cualquier forma ilegal, en particular sobre la base del origen étnico, origen nacional, sexo, discapacidad, capacidad intelectual, medidas de rendimiento o aptitud, habilidad atlética, raza, credo, sexo , origen nacional, religión o ascendencia. Una escuela no puede requerir acción alguna por un estudiante o de la familia (por ejemplo, una prueba de admisión, la entrevista, el ensayo, la asistencia a una sesión de información, etc) con el fin de que el solicitante sea recibir o presentar una solicitud de admisión a la escuela.