Midtown Achievement Program - School Year 2010-2011

Thank you for applying for the Midtown Achievement Program!

Program Schedule:

7th Graders: Tuesdays - 6:30 - 9:00 p.m. & Saturdays 1:00 - 3:00 p.m.

8th Graders: Wednesdays - 6:30 - 9:00 p.m. & Saturdays 1:00 - 3:00 p.m.

Student Last Name *

Student First Name *

What Grade is your Son in? *

School Attending *

Student Date of Birth *

Mailing Address *

City, State, Zip Code *

Home Telephone Number *

Father Cell Number *

Mother Cell Phone *

Mother or Father E-mail Address (that is used and checked often) *

Father's Name *

Father Living at Home? *

Father's Occupation *

Mother's Name *

Mother Living at Home? *

Mother's Occupation *

Annual Household Income (required information; kept confidential) *

This income is required because in order to maintain funding Midtown must annually report the average income of all program participants. Your income is averaged in with all Midtown families. Midtown will never share your personal income information with anyone.

Number of people living in your household *

Your application is nearly complete!

In order to complete the application process, please submit a copy of your son's final report card from last year. You may submit this in one of three ways:

Fax: 773-292-0203, ATTN: Michael Marchewski

Mail: Midtown Achievement Program, 1819 N. Wood St., Chicago IL 60622

Electronically: mmarchewski@midtown-metro.org

If you are new to the program, you will be contact by Michael Marchewski, Program Manager, to set up an interview day and time. He can be reached directly at 773-292-2665.

Returning students will receive an acceptance or rejection letter within one week.

Finally, the program fee is $250 for the entire school year. Please bring or send in a deposit ($75 preferably) as soon as possible. Contact Mr. Marchewski about financial aid information, if necessary.

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