Urban Youth Impact: The Leadership Academy Application 2019-2020

ATTENTION!!!! ATTENTION!!! PLEASE READ!!!!

UYI

Urban Youth Impact's mission is to love, equip and empower inner-city youth to fulfill their God given purpose.

We want to fully engage our backyard, the Tamarind Avenue Community. Going forward, students that reside in this area will receive top priority for admittance into TLA.

*A smaller portion of students outside of this community will also be considered.

This year families will partner and participate with UYI in specific volunteer services, classes and personal training opportunities for students and parents throughout the school year. For each session that you complete, a portion of your payment will be refunded to you!

A schedule will be sent out at the beginning of the school year with opportunities for you to sign up! You will be able to select dates that will be most convenient for you and your family to participate.

I agree and attest to the above stated information. I will diligently select dates when they become available.

Welcome Page

UYI

Dear Parents/Guardians,

We are very excited that you have expressed an interest in learning more about Urban Youth Impact’s after-school program, The Leadership Academy (TLA). TLA is an after-school program that focuses on the Lord, literacy, and leadership. As a faith-based organization, our goal is to build Christ-like leaders. The TLA staff is committed to love, equip, and empower every child entrusted to our care. TLA's goal is to cater to the needs of the whole child through its distinctive program fundamentals. During program hours, the staff will assist students with homework, encourage a love of reading and learning, teach and enhance life skills, offer leadership training, enforce discipline, participate in recreational- and spiritual-based activities, such as chapel and small group sessions, and provide a loving, safe environment for every child. Part of the uniqueness of TLA is that we also offer additional classes to our students called SMART (Science Meets ART). In SMART, the students are afforded an opportunity to enhance their learning experiences through science and art related classes.

TLA has been designed to run in conjunction with the Palm Beach County Schools. We try to mirror the PBCS's calendar, in terms of days off, holidays and vacations. However, our start and end dates usually vary slightly from that of the PBCS. TLA 2019-2020 will be accepting applications for interested parents/guardians, as long as space allows. If you are interested in applying for the 2019-2020 school year, please read the information below, prior to completing this application.

TLA is accepting applications for students going into grades K-8th in the 2019-2020 school year.
All Middle School students are now required to interview prior to being accepted into the program.

In order to be considered for enrollment, the application must be fully complete, all necessary documents/forms must be electronically signed by the parent/guardian and a copy of the student’s 2018-2019 FINAL report cards must be received. (Kindergarten applicants are not required to submit a report card, prior to acceptance).
TLA program will start on September 3, 2019. The hours of operation are on Monday – Friday, 2:15-5:45 p.m., excluding major holidays and/or school closings.
TLA non-refundable annual enrollment fee: $75 for first child and $150 per family.
UYI currently provides bus transportation for the after-school program from the following schools: Roosevelt Elementary, Northboro Elementary, UB Kinsey/Palmview Elementary, Westward Elementary, and Roosevelt Middle School. If your child does not attend any of the above-listed schools, the parent/guardian will be responsible for transporting their child to TLA program each day on time.
An afternoon snack is provided each day for students during program time.
Each week all students are engaged in spiritual enrichment activities and SMART classes.
UYI also offers additional transportation services for parents/guardians who are interested in having their child dropped-off after TLA program ends during the week. An additional transportation fee of $50/per household will be required. Please take note of the transportation zones for drop-off services.

Transportation Zone:

North: 25th Street
East: Rosemary/Spruce
West: Australian/Mangonia Circle
South: 3rd Street

*** More details will be provided regarding the drop-off locations prior to the start of programming. Parents/Guardians will be required to complete a transportation form for their child once details have been established.

In conclusion, there are limited spots available for each grade level. Applications will be reviewed, and authorizing documents will be sent for completion. Please be advised that submitting this application does not guarantee your child a place in the upcoming fall TLA program. If you are interested in completing an application, please proceed to the next pages. Incomplete applications will not be considered.

**** Please note that your attendance to a MANDATORY Parent/Student Orientation prior to the start of TLA is contingent to your child's acceptance

Should you have any other questions, comments, and/or concerns, please feel free to contact our administrative office for assistance.

With kind regards,

TLA Management Team
561.832.9220

programsmanagement@urbanyouthimpact.com

General Information

UYI

Submission of an application does not guarantee that your child will be accepted into the program. You will be notified if your child is accepted.

*Please notify the UYI Program Administrator if any of this following information changes.*

Date of application

How did you hear about us?

Parent/Guardian's Information

Which community/neighborhood do you live in?

If "Other", please list community or city?

Parent/Guardian's First Name

Parent/Guardian's Last Name

Parent/Guardian Cell Phone

Phone carrier

Parent/Guardian's email

Parent/Guardian's optional phone

Street Address

City

State

Zip Code

Total number of people in household:

Total annual household income

Please list the names and ages of your children that you do NOT intend to enroll on this application for TLA. This information may be used for our annual UYI events (Back 2 School Blast & The Christmas Store). select N/A if this does not apply

Other Parent/Guardian's Information

Other Parent/Guardian's First Name

Other Parent/Guardian's Last Name

Other Parent/Guardian Cell Phone

Other Parent/Guardian Cell Phone carrier

Other Parent/Guardian's email

Other Parent/Guardian's alternate phone

ALL INFORMATION IS KEPT CONFIDENTIAL

Student 1 cont.

UYI

Student 1 Information Continued...

Who does the child live with?

What is your relation to the child?

Authorized to release to mother?

YesNo

Authorized to release to father?

YesNo

Do you authorize your child be picked up by someone other than the parent/guardian on this application?

YesNo

If you answered "Yes" to the above question, please enter full name and the relation of person picking up the student. Your child will ONLY be released to the those persons listed below. We will not release your child to anyone who is not identified on this application without your consent. **All individuals picking up students are required to present photo ID.

Transportation

*** Please note: If you do not live in our transportation zone, it will be your responsibility to provide transportation to and from program from your child.

Transportation to UYI: The UYI bus/van picks up students from select schools each day. This service is included in enrollment. Please identify from the UYI school pick-up locations which school your child will attend. If your child does not attend any of the below listed schools, it is the responsibility of the parent/guardian to transport your child to TLA program each day.

Spiritual Enrichment

As a faith-based organization, we incorporate a number of program components such as: Bible Study, Chapel, community service, Praise and Worship, Small Group, etc. that involve spiritual enrichment and development. If your religious affiliation prevents or forbids your child from participating in any of the categories above, please inform us.

My child CANNOT participate in the activities listed aboveMy child CAN participate in all activities

ALL INFORMATION IS KEPT CONFIDENTIAL

Transportation

UYI

If transportation is requested from UYI, the buses and vans will only be traveling within the following West Palm Beach radius:

North: 25th Street
East: Rosemary/Spruce
West: Australian/Mangonia Circle
South: 3rd Street

*** Please note: If you do not live in our transportation zone, it will be your responsibility to provide transportation to and from program from your child.

Transportation from UYI: The UYI bus/van can drop students off near/at home, within the defined limits; however, there is a fee of $50 per family associated with this service.

Will your student require UYI bus/van take home services during the TLA 2019-2020 school year?

YesNo

Signature/Authorization to process application

Please print your name to authorize processing of this application.

ALL INFORMATION IS KEPT CONFIDENTIAL

Enrollment Conditions

UYI

BEFORE SUBMITTING THIS APPLICATION: please read

Requirements for enrollment consideration are:

Completed Application
Payment
End of the Year 2018-2019 Report Card for each student (1st grade - 8th grade)

In order to be considered for enrollment all the terms above need to be completed. You do not need a PayPal account to make a payment. Remember that payment does not guarantee a spot in TLA. Refunds will be issued within two weeks from the start of TLA and will be processed in the order and fashion they were made. Refunds will only be issued if your child is not accepted into the TLA program.

Payment Options

Do you wish to use PayPal to make your payment?

YesNo

You will be emailed a link to make a payment. Please do not make a payment until you have filled out an application for all of your children you wish to be considered for enrollment! Do you understand?

YesNo

You may come into Urban Youth Impact at 2823 N. Australian Ave., West Palm Beach, FL 33404 between the hours of 9am-4pm to make a payment via cash or card. Do you wish to make a payment in person?

YesNo

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