Aloma D Johnson Fruit Belt Community Charter School
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"Private School
Education
for Free."

Leadership Development | Entrepreneurial Development | Instruction In English and Spanish

Ask yourself...
are you satisfied with your
child's
school?

Aloma D. Johnson Fruit Belt Community Charter School | 833 Michigan Ave., Buffalo, NY 14203 | (716) 856-4390 | aleavy@fruitbeltcharter.org

 

Applications

Please click on the appropriate application form below:

Please fill out the application and return it using one of the
following methods:

  • Fax: (716) 856-4391
  • E-mail: aleavy@fruitbeltcharter.org  
  • Mail:
    Aloma D Johnson Fruit Belt Community Charter School
    833 Michigan Ave.
    Buffalo, NY 14203-1207

 

Enrollment for your child
Today's Date
Current Grade
Grade level student will be entering in 2009-2010
Name
Child's Gender
Date of Birth
Place of Birth
Ethnicity
Mother
Father
Street Address
Apt#
City, State, Zip
Relationship of Legally Responsible Adult(s) at this Address
Home Phone #
Is this number listed?
Yes
No
Other important Phone #'s
Dominant Language Spoken at Home
Health or Safety Issues
Emergency Contact Name
Relationship
Phone Number
Emergency Contact Name
Relationship
Phone Number
List Schools attended, beginning with most recent:
Full Name
Grade in 09/10
Full Name
Grade in 09/10
Full Name
Grade in 09/10
Full Name
Grade in 09/10

Student information (information should appear as found on the child's Birth Certificate)

Last, First, Middle
(1. American Indian 2. African American (not Hispanic Origin) 3. Asian or Pacific Islander 4. Hispanic 5. White (not Hispanic))
Last, First, Maiden
Last, First
Address of adult with whom student resides
(Work #, Cell #, Other contacts - Please specify number and name of contact)

Student Emergency Information

Required Data for School Use

Siblings also applying to Aloma D. Johnson Fruit Belt Community Charter School
(A separate application is required for each student applying)

Click the Submit button below in order to submit your application 

Aloma D. Johnson Fruit Belt Community Charter School Online Application Form

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