STUDENT INFORMATION (* denotes required field)
*First Name:
Middle Name:
*Last name:
*Date of Birth:
*Grade as of August 29:
*Gender:
*Home School District:
   
PARENT INFORMATION
*First Name:
Middle Name:
*Last Name:
*Relation to Student:
*Address:
*City:
*State:
*Zip Code:
*Home Telephone:
Work Telephone:
Cell Phone:
*E-mail Address:
   
SIBLING INFORMATION INFORMATION
Please list students who are also applying to this school. You will need to fill out separate applications for each student.
 
Sibling Number One
First Name:
Middle Name:
Last Name:
DOB Month:
Grade as of August 29:
Gender:
Home School District:
   
Sibling Number Two
First Name:
Middle Name:
Last Name:
DOB Month:
Grade as August 29:
Gender:
Home School District:
   
Sibling Number Three
First Name:
Middle Name:
Last Name:
DOB Month:
Grade as of August 29:
Gender:
Home School District:
CONFIRMATIONS
 
I understand that at each grade level, where there are more student applications than spaces available, a lottery will be held for admission. If the oldest child in a family is selected, sisters and brothers desiring enrollment will be admitted if space is available. If any child is enrolled at a non-lottery age level, brothers and sisters will be admitted if space is available. Siblings of currently enrolled students receive priority and are placed before the lottery. In all other cases, I understand that enrollment is not guaranteed for all siblings.*
   
I affirm that the above information is correct and complete to the best of my knowledge.*
   
 
IMPORTANT: Once your application is processed, you will receive your lottery number. If you do not receive your number before Wednesday, March 17, please contact us at 317-713-4218.
 

Fountain Square Academy | 1615 S. Barth Avenue | Indianapolis, IN 46203
Phone: 317-951-1000 | Fax: 317-423-2507 | FSAnfo@fountainsquareacademy.org

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