600 St.

Anns Avenue
Bronx, New York 10455
T 718.292.6543
F 929.220.8110
www.upchs.org

2016-2017 Lottery Application

for Incoming 9th Grade Students
University Prep Charter High School is now accepting student applications. This public high school
provides a comprehensive college-preparatory education.
We are located on the fourth floor of 600 St. Anns Avenue, Bronx, NY 10455 (in the IS 162 Building).
Current 8th grade students may apply. All students entering the 9th grade in September 2016 will be
selected by lottery.
Application Deadline:

April 1, 2016

Mail or Deliver Applications to:

University Prep Charter High School
Attn: Student Admissions
600 St. Anns Avenue
Fourth Floor
Bronx, NY 10455
Lottery: If the number of applications exceeds the capacity of the 9th grade class, students will be
selected by lottery. Preference is given to students residing in Community School District #7 and to
students who have siblings currently enrolled at UPCHS. Students who are not accepted for admission
will be placed on a waitlist in the order determined by the lottery. The lottery will be held on April 6,
2016 at the school at 5:30pm.
Enrollment: All accepted students must complete the schools enrollment process to be added to the
9th grade roster. Failure to complete this process may result in forfeiture of acceptance to the school.
Incoming 9th grade students must also complete our Summer Bridge program in July and
August. In addition to required enrollment forms, families must present documentation that their child
has received all vaccinations.
University Prep Charter High School does not discriminate against or limit the admission of any
student on any unlawful basis, including on the basis of ethnicity, national origin, gender, disability,
housing status, intellectual ability, measures of achievement or aptitude, athletic ability, race, creed,
national origin, religion or ancestry. It does 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 the school.
For additional information, please call 718-292-6543 or 718-585-0560 between 8:30am and
4:00pm or visit www.upchs.org.

600 St. Anns Avenue

Bronx, New York 10455
T 718.292.6543
F 929.220.8110
www.upchs.org

2016-2017 Lottery Application

Note: A separate application must be completed and submitted for each child applying for admission.

Applicant/Student Information
* Students Name: Last ____________________________ First __________________________________ M.I. _____
* Students Date of Birth: ___________________________________________________________________________
* Students Gender: (Please circle one) Male / Female
* Students Home Address: Street _____________________________________________ Apt. /Floor _____________
City _____________________________ State __________________ Zip _______________
School District of Residence (or NYC Community School District): _________________________________________
Students Current School: _________________________________________________________________________
* Students Current Grade: _________________________________________________________________________
* Grade Applying for: ______________________________________________________________________________
* Does the applicant student have a brother or sister who is currently enrolled at University Prep Charter High
School? (Please circle one) Yes / No
If yes, list brothers or sisters name and current grade level:
* Current Students Name: ____________________________________ Grade Level: _______
* Current Students Name: ____________________________________ Grade Level: _______

Parent/Guardian Information
* Parents/Guardians Name: Last _______________________ First ______________________________ M.I. _______
* Relationship to Student: __________________________________________________________________________
* Parents/Guardians Home Address: Street _____________________________________ Apt. /Floor _____________
City _________________________ State ________________ Zip____________
* Parent/Guardians Phone Number(s):________________________________________________________________
Parents/Guardians Email Address: ________________________________________________________________

* Parent/Guardian Signature: __________________________________ Date: _________________________________

* The items marked with an asterisk (*) are the only items that are required in order to apply to University Prep Charter High
School. Any items not marked by an asterisk (*) are optional.