Urban Youth Impact: The Leadership Academy Application 2021-2022              


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



The Leadership Academy (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. 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 G-time 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 CREATE (Connecting, Restoring and Empowering Artists Through Experiences). In CREATE, students enhance their learning through science and art related classes.  



At UYI we highly value attendance. In order to fulfill our purpose and mission, consistent attendance is priority. Every child must attend program 4 out of the 5 days of each week. There are no excused absences accommodating after school activities outside of UYI. We know and understand that there are many opportunities outside of UYI, however, our program is designed for a consistent commitment. Without meeting our attendance policy, each student is not receiving the full experience of being a UYI student and does not have the adequate time to fulfill UYI requirements. Please plan accordingly. Your child will not be admitted into TLA if they are not able to attend 4 out of the 5 days of the week.

Welcome Page


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 has been designed to run in conjunction with Palm Beach County Schools.  We attempt to match PBCS's calendar in terms of days off, holidays and vacations.  However, our start and end dates vary slightly from that of the PBCS. If you are interested in applying for the 2021-2022 school year, please read the information below, prior to completing this application.


TLA is accepting applications for students going into grades 2nd-8th in the 2021-2022 school year. Only K-1st grades students enrolled at Jupiter Christian School at Urban Youth Impact are eligible to apply for TLA. Based on UYI's organizational mission, students whose address is within the Tamarind Avenue Corridor (1st-36th Street) will be considered first. Once all spots fill, other applicants will be placed on the wait list. TLA no longer requires a payment and your student(s) may enroll free of charge. In order for any students to be considered for enrollment each of the following requirements must be met in order to be considered:

the application must be completed in full.
- all necessary documents must be electronically signed by the parent/guardian (DocuSign Electronic Documents). 
- a submission of the student’s 2020-2021 FINAL report card must be received (Kindergarten applicants are not required to submit a report card).

TLA will begin on September 8th, 2021. The hours of operation are Monday – Friday, 2:15 p.m-5:45 p.m., excluding major holidays and/or school closings. UYI currently provides transportation from the following schools: Roosevelt Elementary, U.B. Kinsey Elementary, Westward Elementary, and Roosevelt Middle School.  If your child does not attend any of the above-listed schools, the parents/guardians will be responsible for transporting their child to TLA each day on time. An afternoon snack is provided each day for students during TLA. Each week students engage in spiritual enrichment activities and CREATE classes. 

UYI offers transportation services home for parents/guardians who are interested and who live within our transportation zone. Please take note of the transportation zones for drop-off services.

Transportation Zone:   

North: 36th Street

East: Broadway/Spruce/Rosemary

West: (From North to South) Australian/Mangonia Circle/7th Street

South: 1st Street

There is a limited capacity of seating, transportation may be on a first come first serve basis.


Every child will be literacy tested if they are accepted into TLA. If your child falls two or more grade levels below their grade level they will be provided with additional literacy support. This means literacy coaching may take precedence over other TLA activities. If your child is two or more grade levels below and you wish to opt-out of the additional literacy support, you will need to contact the Literacy Intervention Coach. 

**** Please note that your child's acceptance into TLA is contingent upon your attendance at our MANDATORY Parent Orientation prior to the start of TLA. ****  


Please be advised that submitting this application does not guarantee your child a place in TLA in the fall. You will receive an email confirming your child's enrollment and a phone call prior to program to confirm attendance. If you are interested in completing an application, please proceed to the next page.  Should you have any other questions, comments, and/or concerns, contact our administrative office for assistance. 


With kind regards,


Will Mydock

Program Administrator
561.832.9220 x 200


General Information


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

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

Parent/Guardian's Information
Please note that all communication from TLA staff will be made via the contact information provided for Parent/Guardian 1. If other communication is desired, please contact the Program Administrator to specify.   

Other Parent/Guardian's Information

                                                ALL INFORMATION IS CONFIDENTIAL

Student 1


Student Information


School 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.

Emergency Contact Information

Student's Health History Form

Insurance Information

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. 

*Note that UYI will contact a different physician if we are unable to contact the child's primary care physician*
                                                ALL INFORMATION IS CONFIDENTIAL

Student 1 cont.


Student 1 Information Continued...

Spiritual Enrichment

                                              ALL INFORMATION IS CONFIDENTIAL



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

f transportation is requested from UYI, the bus and vans will only travel within the following radius: 

North: 36th Street

East: Broadway/Spruce/Rosemary

West: Australian/Mangonia Circle/ 7th Street

South: 1st Street

The UYI bus/van can drop students off near/at home, within the defined limits. 

Signature/Authorization to process application

                                       ALL INFORMATION IS CONFIDENTIAL

Enrollment Conditions



Priority enrollment factors are as follows:
  • Completed Application
  • Residence in the Tamarind Avenue Corridor
  • End of the Year 2020-2021 Report Card for each student (1st grade - 8th grade)
In order to be considered for enrollment all the terms above need to be complete.