MOSAICS Public School Lottery Application for 2021-22
By completing this application, you are entering your child into the lottery for the 2021-22 school year.  Completing this application does not guarantee your child a spot at MOSAICS Public School.  There are 60 seats available in kindergarten.  1st grade through 5th grade will have seats available based on the number of students currently enrolled who return.

The lottery will be held on April 10 , 2021.  Applications are due on April 3, 2021.  Applications submitted after April 3, 2021 will be placed on the waiting list in the order received. If spaces are available, families will be contacted and will be able to enroll their child for the 2021-22 school year.  

When filling out your application, please note that kindergartners must be age 5 on or before Sept 1, 2021 and first graders must be 6 on or before Sept 1, 2021. Proof of family relationship may be required for verification. Upon acceptance into MOSAICS Public School, a birth certificate, proof of residence, 504, IEP, and immunization records will be requested for verification.

For more information about the lottery process, please visit www.mosaicsps.org/enroll.  

All prospective students will be given the opportunity to enroll regardless of race, color, national or ethnic origin, religion, gender or social or economic status or special needs.



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Email *
How did you hear about MOSAICS? *
Required
Parent/Legal Guardian First and Last Name *
Additional Parent/Legal Guardian First and Last Name
Home Address (Street, City, Zip Code) *
Do you live within the MOSAICS' attendance zone? *
Mailing Address --if different than home  (Street, City, Zip Code)
Phone Number (with Area Code) *
Additional Phone Number  (with Area Code)
Additional E-mail Addresses (Please enter all the email addresses that you check frequently.  Separate emails by comma.)
Do you have a child who attends MOSAICS already? *
Please list the name(s) of your child(ren) who already attend MOSAICS:
What is the first name of the child you would like to enroll? *
What is the last name of the child you would like to enroll? *
What is your child's date of birth? Please note that kindergartners must be age 5 on or before Sept 1, 2021 and first graders must be 6 on or before Sept 1, 2021. *
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Which grade will he or she be enrolling into in 2021-22? *
Name of  last school attended *
Before submitting this application, the parent or legal guardian of the children understand the following: I understand that any false or incorrect information on this application could jeopardize my child's enrollment should he/she be selected to attend MOSAICS Public School. I am authorized to sign as parent/legal guardian of the child(ren) on this application and the child(ren) on this application resides with me at least 50% of the time. Please sign electronically below. *
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