826CHI Student Application

STUDENT





















Income Chart
Income Chart
PRIMARY PARENT OR GUARDIAN #1

Note: Please advise us of any changes regarding custody of the student.














PRIMARY PARENT OR GUARDIAN #2

Note: Please advise us of any changes regarding custody of the student.
















EMERGENCY CONTACT #1













EMERGENCY CONTACT #2













LANGUAGE(S)





For multiple selections hold Ctrl or Command.

RACE/ETHNICITY


GENDER


GENDER PRONOUNS


MEDICAL INFORMATION








If you answered yes to any of the above, please fill out the Food Allergy and Anaphylaxis form and return to 826CHI. 








Should your student change medications and/or doses, please notify us so we can make the appropriate changes to this information.
PRIORITY ENROLLMENT STATEMENT ACKNOWLEDGEMENT
Arts education is not equitable in the city of Chicago. Over 24,000 Chicago Public School students receive little to no arts instruction. In order to maximize opportunities for access experienced by marginalized groups, 826CHI utilizes a priority enrollment selection process. We prioritize Black, Indigenous, People of Color (BIPOC) students, limited-income students, gender non-conforming, non-binary, and trans students. The 826CHI team will carefully evaluate each application and select students, schools, and partners that align with our priority enrollment criteria. We prioritize community and neighborhood schools that do not have selective enrollment and have a low number of existing arts partnerships, as well as students and classes with low-proficiency English Language Learners. 
VIRTUAL INTERACTION GUIDELINES FOR STUDENTS & PARENTS ACKNOWLEDGEMENT
  1. 826CHI will comply with the Children’s Online Privacy Protection Act (COPPA) Congress enacted the Children’s Online Privacy Protection Act (COPPA) in 1998.  COPPA required the Federal Trade Commission to issue and enforce regulations concerning children’s online privacy. The primary goal of COPPA is to place parents in control over what information is collected from their young children online. The Rule was designed to protect children under age 13 while accounting for the dynamic nature of the Internet. The Rule applies to operators of commercial websites and online services (including mobile apps) directed to children under 13 that collect, use, or disclose personal information from children, and operators of general audience websites or online services with actual knowledge that they are collecting, using, or disclosing personal information from children under 13. The Rule also applies to websites or online services that have actual knowledge that they are collecting personal information directly from users of another website or online service directed to children. Read more here: https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-reform-proceedings/childrens-online-privacy-protection-rule
  2. 826CHI will comply with the CPS Acceptable Use Policy as applicable to 826CHI’s Virtual sessions. Students shall not use the internet, collaboration tools, bulk communication tools, social media or email to use, upload, post, mail, display, store, or otherwise transmit in any manner, any content, communication or information that, among other unacceptable uses: Is hateful, harassing, threatening, libelous, defamatory or otherwise meant to bully or intimidate others; Is offensive or discriminatory to persons based on race, ethnicity, national origin, gender, gender identity, sexual orientation, age, physical or mental illness or disability, marital status, economic status, immigration status, religion, personal appearance or other visible characteristics; Constitutes or furthers any criminal offense, or gives rise to civil liability, under any applicable law, including, without limitation, U.S. export control laws or U.S. patent, trademark or copyright laws; Constitutes use for, or in support of, any obscene or pornographic purpose including, but not limited to, the transmitting, retrieving or viewing of any profane, obscene, or sexually explicit material; Constitutes use for soliciting or distributing information with the intent to incite violence, cause personal harm or bodily injury, or to harass, threaten, or “stalk” another individual; Contains a virus, trojan horse, ransomware or other harmful component or malicious code; Constitutes junk mail, phishing, spam or unauthorized broadcast email; Violates the security of any other computer or network or constitutes unauthorized access or attempts to circumvent any security measures; Obtains access to another individual’s account, files or data, or modifies their files, data or passwords; Impersonates any person living or dead, organization, business, or other entity; Degrades the performance of, causes a security risk or otherwise threatens the integrity or efficient operation of 826CHI virtual interactions; Enables or constitutes wagering or gambling of any kind; Accesses, distributes or uses games except when an assigned educational activity; Promotes or participates in any way in unauthorized raffles or fundraisers; Engages in private business, commercial or other activities for personal financial gain; Accesses or distributes unauthorized information regarding user passwords or security systems; Engages in hacking (intentionally gaining access by illegal means or without authorization) to access unauthorized information, or to otherwise circumvent information security systems; Engages in inappropriate sexual conduct, including unwelcome sexual contact, indecent exposure, transmitting sexually suggestive images, or other sexual activities; Constitutes use that disrupts the proper and orderly operation of the program; Accesses or distributes non-educational materials or inappropriate content or materials. Read more here: https://cps.edu/AcceptableUsePolicy/Pages/aup.aspx
  3. 826CHI parents and students consent to having sessions recorded to comply with incident-reporting standards for engaging with students virtually. The recordings will be archived after each session and the content of the recordings will not be used, shared or disseminated in any way unless it is used as detailed in our photo, video, and radio permission and as evidence for an incident report as all 826CHI staff are mandated reporters. 
  4. Parents may address staff at any point of the session to ask a question or pose a concern 
RELEASE, INFORMED CONSENT AND LICENSE AGREEMENT, AND PHOTO, VIDEO, & RADIO FOOTAGE PERMISSION

PLEASE NOTE:

826CHI is a nonprofit organization and a chapter of the 826 National network, both of which are dedicated to supporting under-resourced students ages 6 to 18 with their creative and expository writing skills and to helping teachers inspire their students to write. For all permission and release information below, “826CHI,” “we” and “us” collectively refers to 826CHI and/or 826 National.  The "Author" refers to the student participating in 826CHI's program. This form is an agreement between the participating student if over 18 or the parent(s)/guardian(s) of the participating student if under 18 and 826CHI.


A NOTE ON IN-CENTER PROGRAMS:

826CHI is a writing center, where students may come to work on and receive assistance with school or individual work. Although students are encouraged to feel at home while in the center, they are also expected to have homework to do, and to be respectful of their surroundings. We reserve the right to ask students we feel are being too disruptive to leave. Please understand that 826CHI is a writing center and should not be considered an alternative to daycare or babysitting services. We specialize in writing instruction, therefore homework in other subjects will not be prioritized. While we will do our best to accommodate any student that comes to the center, we do have a limited amount of space. Accordingly, we cannot allow drop-in tutoring; all students must sign up for after-school writing lab in advance. Parents are responsible for making any necessary arrangements for getting their child home.







CONSENT TO EMERGENCY MEDICAL OR DENTAL TREATMENT

IN-PERSON PROGRAMMING LIABILITY RELEASE FOR ACCIDENTAL INJURY OR EXPOSURE

PUBLISHING PERMISSION

FILM, PHOTOGRAPHY, AUDIO, AND MEDIA PERMISSION
During 826CHI programming, 826CHI may document the work of the student authors through photography, film, video, audio, or other recording techniques. Students agree that these images and recordings may thereafter appear in 826CHI publications, reports, film productions, websites, or social or online media platforms. This documentation shares the hard work of the students and more information about 826CHI’s programs and impact. No material will be used for commercial purposes. 826CHI may also wish to use this material in promotional materials (which may include 826CHI fact books, websites, or social or online media platforms) on the radio, television, in press articles, or other media about 826CHI, including partnerships and promotions benefiting 826CHI. These materials provide the public with helpful information about programs at 826CHI and amplify students’ work to a broader audience. 

SCHOOL CONTACT PERMISSION

PERMISSION FOR FEEDBACK

PERMISSION FOR EMAIL AND MOBILE PHONE NUMBER COLLECTION AND COMMUNICATION


This is VERY important— information about TWS will be communicated via email throughout the year. Please write your student's main email address, the one that they check regularly.