MERSD 2021-2022 School Choice Lottery Application

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* 1. Student's Name:

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* 2. Student's Gender:

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* 3. Grade applying to for Fall 2021:

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* 4. Student's Birth Date:

Date

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* 5. Student's Home Phone Number:

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* 6. Student's Home Address:

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* 7. Is student applicant a SIBLING OF A CURRENT choice student?

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* 8. If yes to question 7, current choice student's name, grade and school:

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* 9. Student's present school, grade level, and city/town of residence:

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* 10. Name(s) and age(s) of the siblings who do not attend MERSD:

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