Urban Youth Impact: The Leadership Academy Application 2021-2022

UYI

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

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 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

wmydock@urbanyouthimpact.com

General Information

UYI

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.*

Date of application

How did you hear about us?

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.

Which community/neighborhood do you live in?

If "other", please list community or city?

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Relationship to child:

If other, what is your relationship to the child:

Parent/Guardian 1 Cell Phone

Phone Carrier

Parent/Guardian 1 Email

Parent/Guardian 1 Optional Phone

Street Address

City

If other, what city?

State

Zip Code

Total number of people in household

Total annual household income

Number of children that do not attend TLA

Please list the names and ages of all children that live in your household that you do NOT intend to enroll in TLA. This information may be used for our annual UYI events. Select N/A if this does not apply

Other Parent/Guardian's Information

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Cell Phone

Relationship to the child

Parent/Guardian 2 Cell Phone Carrier

Parent/Guardian 2 Email

Parent/Guardian 2 Alternate Phone

ALL INFORMATION IS 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 to be picked up by someone other than the parents/guardians on this application?

YesNo

If you answered "yes" to the above question, please enter the full name, phone number and the relation of the person(s) picking up your child. Your child will ONLY be released to people listed within this application. We will not release your child to anyone who is not identified on this application without parent/guardian consent. All individuals picking up children are required to present photo ID.

Spiritual Enrichment

As a faith-based organization, we incorporate a number of program components such as: Bible study, God-Time, community service, praise and worship, small groups, 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 CONFIDENTIAL

Transportation

UYI

*** 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.***

If 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.

Will your child require UYI bus/van take home services during the TLA 2021-2022 school year?

YesNo

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

Other:

Signature/Authorization to process application

I attest that all of the information submitted in this application is true and I give my permission to process the application.

ALL INFORMATION IS CONFIDENTIAL

Enrollment Conditions

UYI

BEFORE SUBMITTING THIS APPLICATION: please read

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.

Epilepsy	Convulsions
Fainting	Heart Condition
Asthma/Wheezing	Frequent Stomach Upsets
Hearing Problems	Ear Infections
Rheumatic Fever	Diabetes
Allergies	Other
None of the above