Urban Youth Impact: The Leadership Academy Application 2018-2019                

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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 is a literacy and leadership focused after-school program. 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 learning, teach and enhance life skills, offer leadership training, enforce discipline, participate in recreational and spiritually 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 calendar, in terms of days off, holidays, and vacations.  However, our start and end dates usually vary slightly from that of the PBCS. TLA 2018-2019 will be accepting applications for interested parents/guardians, as long as space allows.  If you are interested in applying for the 2018-2019 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 2018-2019 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, a copy of the student’s 2017-2018 FINAL report cards must be received, and the annual enrollment fee must be received. (Kindergarten applicants are not required to submit a report card, prior to acceptance).

·    TLA program will start on September 4, 2018. 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; $50 for second child; and/or $150 per family with 3 or more children (for siblings and/or relatives living in the same household).

·    UYI currently provides bus transportation for the after-school program from the following schools: Roosevelt Elementary, Northboro Elementary, U B Kinsey/Palmview Elementary, Westward Elementary, and Roosevelt Middle School.  However, 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:   Northbound: 36th Street

                                        Eastbound: Pinewood/Spruce Street

                                        Westbound: Congress - Hank Aaron/Fire House

                                        Southbound: 2nd 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 programming.  If you are interested in completing an application, please proceed to the next pages.  Incomplete applications will not be considered.

**** The deadline for early enrollment is July 13, 2018.  All applications received before July 13th will be placed on a special early enrollment list for the Back 2 School Blast event.  Applications received after this deadline will still be accepted, however, those applicants will not be placed on the early enrollment list.   Someone will contact you regarding your participation in the MANDATORY parent/student orientation during the B2SB event. Please do not delay to apply; spaces will go quickly again this year! ****


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


With kind regards,

 Felicia Harrison

Program Administrator

561.832-9220 Ext. 150



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Only one child per application.  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.*

Student's Information


Program enrichments begins at 2:30pm. If your child is unable to be here by 3:30pm at the latest, they will NOT be eligible to attend our program. This is due to the fact that your student will not be able to benefit from the full scope of our services.

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Parent/Guardian's Information

Other Parent/Guardian's Information

Emergency Contact's Information

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Student's Health History Form

ex. 5'10''

Approximate number, is fine. 

To Select More Than One: - On a Mac please hold the Command Button and click your mouse - On a PC please hold down the control button and click your mouse

In the event of an accident, injury, or illness that requires emergency medical treatment, your child's medical expenses will be covered by your primary insurance carrier.  If your child does not currently have health insurance coverage, the Parent/Guardian is fully responsible for any medical expenses incurred. 

Insurance Information

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Additional Information

Spiritual Enrichment

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