Student Application Form
*Required field  

What School Year is this Application for? What School Year is this Application for? 2023-2024 Academic Year 2024-2025 Academic Year

Scholar's First Name*

Scholar's Middle Name*

Scholar's Last Name*

Birth Date*

Current Grade* Current Grade* 4 5 6 7

Current School*

Baltimore City Schools ID# (if known):

Is this the first application being submitted for this scholar?* Is this the first application being submitted for this scholar?* Yes No

Parent/Guardian Name*

Relationship to child*

Are you the legal guardian of the child?* Are you the legal guardian of the child?* Yes No

Street Address*

State*

City*

Zip Code*

Email Address*

Cell Number*

Best means of contacting parent/guardian* Best means of contacting parent/guardian* Cell Phone Email

Does the scholar have a sister applying to LMCJS?* Does the scholar have a sister applying to LMCJS?* Yes No

If so, Name of Sister:

How did you learn about us?* How did you learn about us?* Family Member Scholar Friend Coworker Website Mail Social Media School Fair Other

Were you refered by anyone? Were you refered by anyone? Yes No

Who refered you?

Do you have anyone you would like to refer to us? Do you have anyone you would like to refer to us? Yes No

Please share the name, guardian name and guarduan contact information for the scholar you would like to refer.

Signature* (Please Initial)