2015-2016 SCHOOL YEAR WAIT LIST APPLICATION Thank you for your interest in The Academy for Global Citizenship. The deadline for the 2015-2016 Enrollment Lottery was February 27, 2015. Please complete and submit this form to be added into the 2015-2016 Wait List. This Intent is valid for the school year: 2015-2016. Falsifications, misrepresentations, or omissions may disqualify your application. Information you supply will not be given to any other person/company for any purpose. Applications received unsigned or incomplete may not be considered for acceptance. Please type or print clearly using black or blue ink.. A Confirmation that we have received your application will be sent to you within 3 business days. Children must be Age: 5 on or before September 1 51, 2015 for Kindergarten. Applicants must reside in the City of Chicago. If we call you regarding Acceptance, please respond within 24 hours. If we do not call you by December 2015, we recommend applying for the next Lottery. Applicant Student Name Applicant Date of Birth: I I Gender: OMale O Female Month Day Year Applicant Grade Fall 2015: O Kindergarten 01 02 03 04 05 06 07 08 Sibling Information (Brother or sister applying to The Academy for Global Citizenship for 2015-2016): Sibling Name: Date of Birth: / / Gender: O Male O Female FALL 2015 Grade: ----- Parent/Guardian Name: ------------------------------ Home address: ---------------------------------- City:---------------- State: Zip code:--------- Cell Phone: ------------- Other Telephone:------------ E-mail: ------------------------------------~ How did you find Academy for Global Citizenship? (Optional): ----------------- Student Educational Information (Optional) Previous School Name: ------------------------------ 0 CPS School 0 Private School OHome I certify that all information contained within this application packet is correct and understand that any misrepresentation or falsifications of information herein requested constitutes ground for immediate dismissal from any subsequent admission to or attendance at The Academy for Global Citizenship. Signature:-----------------------Date:----------- Admissions Office: 4647 W. 4ih St., Chicago, Illinois 60632 t(773) 582.1100 Ext. 10 Fax. (773) 582-1101 @ admissions@agcchicago.org <jg www.agcchicago.org

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7/1512015 Student Enrollment I Academy for Global Citizenship The School Academics Sustainability Admissions Get Involved Our Future Student Enrollment Parnnts at AGC Parent Portal \... Intent to Enroll Form/ Enroll at AGC \. La lntenci6n de Matrfcular / Thank you for your interest in enrolling your child at the Academy for Global Citizenship. We would be delighted to welcome you for a visit to our learning community. Our Enrollment Process The Academy for Global Citizenship is an open enrollment. free public school for students living within the City of Chicago. We particularly encourage families in the LeClaire Courts, West Elsdon, and Archer Heights neighborhoods to apply. however, there is no neighborhood boundary or preference given based on residential area. We welcome students, parents. employees. and community members with disabilities. Our building and programming are fully accessible. The Academy for Global Citizenship does not base admission on academic performance. Admission is based on a lottery held each spring. Students applying for kindergarten must be age 5 by September 1st for the year for which they are applying. Students entering any grade level may submit an Intent to Enroll form with the year they wish to enroll clearly marked. The application is valid only for the marked school year. Complete and accurate applications are due by the designated deadline in order to be entered into the blind public lottery held each spring. Any applications received after the due date will be put on the waitlist compiled after the drawing. The deadline for the 2015-2016 lottery has passed, but we are still accepting applications for our 2015-2016 wait list. The 2015-2016 enrollment lottery will be held March 20th, 2015. Prospective family tour dates are typically held on the first Wednesday of every month in English at 10:00 a.m. and in Spanish at 11 :00 a.m. To schedule, please contact Ms. Mares at 773.582.1100ex10. Admissions office located at 4647 W. 47th St The Intent to Enroll form is available in the main office or by clicking the button above. Intent to Enroll forms may be submitted to the office in person, by mail, fax, and e-mail and are accepted on an ongoing basis. Applicants will receive written confirmation stating that the application has been received; the reply may take up to three business days. If you do not receive a reply, your application was not received. On the lottery date, students will be randomly selected for available spaces and for the waitlist. Waitlisted families will be notified immediately if a space becomes available at any point after the lottery. http://agcchicago.org/adm issions/enrol I/ 1/2

7/15/2015 THE ACADEMY FOR GLOBAL CITIZENSHIP: MAIN CAMPUS 4647 WEST 47TH STREET CHICAGO, ILLINOIS 60632 Student Enrollment I Academy for Global Citizenship DONATE THE ACADEMY FOR GLOBAL CITIZENSHIP: ANNEX CAMPUS 4941 WEST 46TH STREET CHICAGO, ILLINOIS 60638 773.582.1100 SARAH ELIZABETH IPPEL ANNE GILLESPIE 851 KWT OF ENERGY PRODUCED IN 2013 THROUGH AGC SOLAR PANELS 11 NUMBER OF COUNTRIES WHO HAVE HAD VISITORS TO AGC 102 NUMBER OF COUNTRIES AGC STAFF HAS VISITED 02 NUMBER OF EGG LAYING SCHOOLYARD CHICKENS 37.5 LBS OF WASTE DIVERTED FROM LANDFILL THROUGH RECYCLING AND COMPOSTING EACH WEEK 88K ORGANIC MEALS SERVED EACH YEAR 350 NUMBER OF STUDENTS CHANGING THE WORLD HOME CONTACT DONATE ADMISSIONS http://agcchicago.org/admissions/enroll/ 212

Intent to Enroll 2015-2016 Thank you for your interest in The Academy for Global Citizenship. Please complete and submit this form before the deadline to be entered into the 2015-2016 Enrollment Lottery. Falsifications, misrepresentations, or omissions may disqualify your application. Information you supply will not be given to any other person/company for any purpose. Applications received unsigned or incomplete may not be considered for acceptance. Please type or print clearly using black or blue ink. This Intent is valid for the school year: 2015-2016. A Confirmation that we have received your application will be sent to you within 3 business days. Children must be Age: 5 on or before September 1st, 2015 for Kindergarten. Applicants must reside in the City of Chicago Applicant Student Name Applicant Date of Birth: I I Gender: OMale O Female Month Day Year Applicant Grade Fall 2015: O Kindergarten 01 02 03 04 05 06 07 Sibling Information (if a brother or sister is applying to The Academy for Global Citizenship for 2015-2016.): oa Sibling Name: Date of Birth: / / Grade: Gender: 0 Male O Female Student Educational Information Previous School Name 0 CPS School (CPS student ID------~ O Private School ----------------------------- Telephone of previous school:------------ Relationship to student: ------------------------------ Home address: ---------------------------------- City: State: Zip code: ---------------- ------- --------- Cell Phone: ------------~ Other Telephone:------------- E-mail:------------------------------------- How did you find Academy for Global Citizenship: --------------------- I certify that all information contained within this application packet is correct and understand that any misrepresentation or falsifications of information herein requested constitutes ground for immediate dismissal from any subsequent admission to or attendance at The Academy for Global Citizenship. Signature: Date:-----------...---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------., i For Office Use Only: i Received in person, by fax, post, or e-mail on Time: by Lot.: i : : L-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.1 i Admissions Office: 4647 W. 4i" St., Chicago, Illinois 60632 C(773) 582. l l 00 Ext. 10 Fax. (773) 582-l l 0 l ~ mmares@agcchicago.org ~ www.agcchicago.org