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Belmont Charter High School Application - 2021-2022

2021-2022 SCHOOL YEAR

Application Deadline is January 29, 2021
Grade Applying for (Please Check One)*
- 9th Grade
- 10th Grade
- 11th Grade
- 12th Grade
Student Information
First Name*
Middle Name
Last Name*
Age*
Date of Birth (MM/DD/YYYY)*
Gender (optional)
- Male
- Female
Current Grade*
Current School*
PARENT/GUARDIAN Information

Note: All students must provide proof of Philadelphia residency upon enrollment.
Full Name*
Relationship*
Full Name
Relationship
Street Address*
Unit / APT
City*
State*
Zip Code*
Primary Phone Number*
Secondary Phone Number
Email Address*
Does the student live at this address?*
- Yes
- No
If no, please include student's current address
Who does the student live with at this address?
Does the applicant have siblings that attend any Belmont Charter Network School?*
- Yes
- No
Sibling Information

Note: ONLY complete this section if the applicant currently has a sibling attending or applying to attend Belmont Charter School.
First Name
Middle Name
Last Name
Current Grade
First Name
Middle Name
Last Name
Current Grade
Is the applicant related to a current employee of the Belmont Charter Network?
- Yes
- No
*If you answered yes please fill in the information below.
Employee Name
A separate application must be submitted for every student each year. Applications will be kept on file for the duration of the school year so that open seats can be filled as they become available. A new application process and new waiting list will be established at the start of the enrollment period for the following school year.

Belmont Charter High School is a tuition-free public school located in Philadelphia, Pennsylvania. Belmont Charter High School values diversity and seeks students from diverse backgrounds. Belmont Charter High School does not discriminate on the basis of race, gender, sexual orientation, religion, ethnic origin, or disability in its admissions policies. If the number of applications exceeds the number of openings, we will hold a public lottery at 5pm on February 10, 2021 at 1301 Belmont Avenue Philadelphia, PA 19104.

Download admission and enrollment policy
Statement of understanding

By checking “Agree” below on this application, I confirm that all information contained in this application is true. I understand that if it is determined that I have falsified any information, this application will be considered null and void.
Agree?*
- Agree

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Belmont Charter High School

Belmont Charter High School Application - 2021-2022

2021-2022 SCHOOL YEAR

Student Information

PARENT/GUARDIAN Information

Sibling Information

Statement of understanding