Complete Online

2017-2018 Student Application Online Form


Mott Haven Academy

All children eligible to attend NYC Public Schools are eligible to attend Mott Haven Academy Charter School.

As a public charter school, Mott Haven Academy will not limit the admission of any student on the basis of disability, race, creed, gender, national origin, religion, ancestry, athleticability, or intellectual aptitude or achievement, nor will we 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. Supports and services are provided for students requiring Individualized Education Plans (IEP’s) and for English Language Learners.

For Pre-Kindergarten, children must turn 4 by 12/31/2017. For Kindergarten, children must turn 5 by 12/31/17. Completing this form shows your desire to enroll your child in the lottery for admission to Mott Haven Academy Charter School.

Application Deadline: Friday, March 31st 2017

Student information

* indicates required field

First Name: *

Last Name: *


Address: *

Apt: *

City: *

State: *

Zip: *

Gender of Child: *

Child’s Birthdate: *

In September 2017, my child is scheduled to be in (check one): *
Pre-KKindergartenGrade 1Grade 2Grade 3Grade 4Grade 5

Primary Parent/Guardian Information

First Name: *

Last Name: *

Address: *

Apt: *

City: *

State: *

Zip: *

Email Address: *

Home Phone: *

Work Phone:

Cellular Phone:

Birth Parent Parent Information (if in foster care)

First Name:

Last Name:

Email Address:


Does the applicant reside in New York City Community School District (CSD) 7?

Children in the Home

Please list other children living in the home, their date of birth, their grade in Sept. 2017, and their relationship to the student applying. Indicate if any of the children currently attend Mott Haven Academy Charter School. If not, please name the school they are currently attending. (Note that a separate application must be submitted for each child applying):

Lottery Preference:
While this school will be open to all students, it is specifically designed to meet the needs of at-risk students who are currently served by the child welfare system. Our lottery system, in compliance with the NY State Charter School Law, allows us to give our target population lottery preference while still creating opportunities for the entire Mott Haven community. By providing us with additional information, your child may qualify for the preference.

1) Seats have been reserved for Children in Foster Care who meet the following criteria:
A Foster Care Student is defined as any child in the custody of the City, away from his home 24 hours per day in a foster boarding home or a duly-certified relative foster boarding home (kinship home) or a duly-certified group home, agency-operated boarding home, child care institution, or any combination thereof1.

Is the child currently in Foster Care?

Is the child currently living in transitional housing?

Seats have been reserved for Children Receiving Prevention Services who meet the following criteria:
A Preventive Service Student is defined as any child receiving supportive and rehabilitative services from an agency for the purpose of (1) Averting a disruption of a family which will or could result in the placement of child in foster care; (2) Enabling a child who has been placed in foster care to return to his or her family at an earlier time than would otherwise be possible; (3) Reducing the likelihood that a child who has been discharged from foster care will return to foster care. Also, children who are living in transitional housing. 2.

Is the child receiving Prevention Services?

Name of the social service agency currently responsible for the child’s Foster or Prevention Services:


Case Worker:


I agree that school records, photos and video of the student for whom I am submitting this application may be used by this charter school and for studies about this charter school. In these studies, only aggregate outcomes, not individual scores or identifying information will be reported. If I have provided information that would make this student applicant eligible for lottery preference, the school has my permission to verify information provided.*

Parent/Guardian Electronic Signature:

Today’s Date:

1 New York State Department of Social Services, Regulations for Foster Care, Title 18.
2 New York State Department of Social Services, Preventive Services Program Manual