Enrollment Application
Jefferson Memorial

PLEASE NOTE: The 2016-2017 School Year still has an active Wait List until April 2017.

The admissions lottery open application period for the 2017–2018 School Year starts January 3, 2017 and closes at 11:59 PM on March 6, 2017.

Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Home Phone *
Parent/Guardian Cell Phone
Parent/Guardian Email *
Note: If your address is not in Frederick County, then you must certify that the child will be a resident of Frederick County by July 1st of the upcoming year.
Parent/Guardian Street Address 1
Parent/Guardian Street Address 2
Parent/Guardian City
Parent/Guardian State
Parent/Guardian Zip Code
Family Code
*Please leave blank unless you have already enrolled another family member(s) for the 2017-18 lottery. If this is a second application for another family member (for the 2017-18 school year), please enter the "family code" that was supplied on your original application confirmation email. This will note students on separate registrations as being siblings. Do not enter a code a from a previous lottery year. This field is only to add a student to a previous application for this school year.
Number Of Students Enrolling *