afterschool academy - Urban League of Rochester

AFTERSCHOOL
ACADEMY
2015 - 2016 School Year Application
Project Achieve
Project Excel
Project Ready PSS STEM
Empowering Communities. Changing Lives.
265 North Clinton Avenue. Rochester, NY 14605
READY, EXCEL, ACHIEVE!
Dear Applicant:
Thank you for your interest in the Urban League of Rochester’s Afterschool Academy. The
Afterschool Academy is an all-inclusive program for students in the 6h through 12th grades. The
program offers academic and life support skills, exposure to the community’s cultural resources,
and college preparation services.
Please return your completed application and other requested documents to:
Afterschool Academy Office
Urban League of Rochester, NY, Inc.
265 North Clinton Avenue
Rochester, New York 14605
Fax #: (585) 325-4864
Phone #: (585) 325-6530
Eligibility/Program Information
 Completed application form
 A copy of your most recent school transcript or report card
 Letter of recommendation from a teacher, pastor, advisor, or an adult who is not a relative
 Attend a school in Monroe County
 If accepted, parent/guardian must arrange transportation to and from the program
 Project Achieve and Project Excel will begin on Tuesday, September 8, 2015 and end June
2016; the programs run from 3:30pm until 6:30pm Mondays-Fridays
 Project Ready PSS STEM meets on Tuesdays and Thursdays from 3:30pm until 6:30pm
 Please be prompt in picking up your child(ren)
 No program session on national holidays and on Rochester City School District’s school
cancellations/closings, unless notified differently by program staff
 All accepted applicants need to attend a mandatory orientation with his/her parent/guardian
 An application DOES NOT guarantee a spot in the program
If you have any questions please contact Charisma Dupree, Program Interim Director, at
325-6530, ext. 3049 or via email at cdupree@ulr.org.
Sincerely,
The Afterschool Academy Staff
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PROGRAM DESCRIPTIONS
The Afterschool Academy is comprised of three programs that aim to
prepare youth for college, work, and life. Below are descriptions for
Project Ready Post-Secondary Success STEM,
Project Excel, and Project Achieve.
PROJECT READY PSS STEM
The Project Ready PostSecondary Success Science,
Technology, Engineering, and
Mathematics program
provides males and females in grades 8 - 12 with
the support, guidance and encouragement
needed to prepare them for a bright and
promising future. Program participants engage in
academic development, cultural awareness,
college exploration, and service learning
projects. Participants also focus on career
exploration, with an emphasis in Science,
Technology, Engineering, and Mathematics.
AFTERSCHOOL ACADEMY
The Afterschool Academy is designed to
prepare youth in grades 6, 7 and 8 with the
skills needed to succeed in school and life.
Staff provides academic support through
homework help and tutoring, enrichment
activities that strengthen
leadership skills, and
exposure to the
community’s cultural
resources. Participants also
receive supplemental support in
the areas of math, language, and technology.
A
A
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Urban League of Rochester, NY, Inc.
Mission
To enable African Americans, Latinos, the poor and other disadvantaged to secure economic
self-reliance, parity, power and civil rights.
Three-pronged strategy:
Ensuring that our children are well educated and equipped for economic self-reliance in the 21st
century;
Helping adults attain economic self-sufficiency through good jobs, homeownership, entrepreneurship and wealth accumulation; and
Ensuring our civil rights by eradicating all barriers to equal participation in the economic and
social mainstream
FOR ADDITIONAL INFORMATION CONTACT:
Afterschool Academy Office
Urban League of Rochester
Phone: 585-325-6530
Fax: 585-325-4864
Fred & Floy Willmott Foundation
SIGNALING FOUNDATION
Empowering Communities. Changing Lives.
Page 4
2015-2016 ACADEMY APPLICATION
To participate in the Afterschool Academy
you will need:
 A completed application
 Your most recent report card
 A letter of recommendation (teacher, counselor, or
community member; not applicable for current students
with one on file)
 An interview accompanied by a parent or
guardian
Indicate which program you are applying for:
 Project Achieve (6th and 7th grade)
 Project Excel (8th grade )
 Project Ready (8th - 12th grade)
Indicate if you are currently enrolled in:
 YIP (Youth Intervention Program)
 Other Urban League programs (specify ______________)
 Other agency’s programs (specify ______________)
Print Name: __________________________________________________
Last
First
RCSD School ID (only for students attending a RCS)
______________________________________
Middle Initial
Permanent Home Address: ______________________________________________________________________________
City: __________________________________ County: ______________________ State: ________ Zip: ______________
Phone: (______)_________________ Date of Birth:____________ Age: ______ Race/Ethnicity: ______________________
School: ____________________________________ Guidance Counselor ________________________________________
Grade 2015-2016(circle one) 6 7 8 9 10 11 12
GPA(14-15 school year)_____
Sex: Female  Male 
Household/Family Information
Mother's/Legal Guardian’s Name: _______________________________________________________________________
Mother’s/Legal Guardian Email Address: _________________________________________________________________
Mother’s/Legal Guardian’s Cell Phone: _____________________________ Work Phone: _________________________
Place of Employment _________________________________________________________________________________
Father's/Legal Guardian's Name: ________________________________________________________________________
Father’s/Legal Guardian Email Address: __________________________________________________________________
Father’s/Legal Guardian’s Cell Phone: _____________________________ Work Phone: __________________________
Place of Employment _________________________________________________________________________________
Will you be the first in your immediate family to attend college?
 Yes
 No
Does anyone in your household speak another language?
 Yes
 No
Total family income: Please check the appropriate category.
 less than $14,999
 $15,000-$24,999
 $25,000-$44,999
 $45,000-$74,999
 $75,000 or greater
Section to be completed by ASA staff:
Date Received: _____/_____/_____
Approval Status: _____________
Staff Initials: _________
Intake Date: _____/_____/_____
Staff Initials: _________
Page 5
PARENT/LEGAL GUARDIAN FORM
I consent to my child’s participation in the AFTERSCHOOL ACADEMY. I am willing to let my child
participate in after-school and weekend academic, social, and personal development activities as
part of the Academy Curriculum. I am willing to receive information about educational
requirements and opportunities at the Urban League for my child as a part of the follow-up
components of this program. I understand that my child’s violation of the program requirements
can lead to his or her termination from the program.
I give permission:
 to have my child’s grades (transcript) released to the Urban League of Rochester to document
academic progress and program effectiveness.
 to use my child’s photograph, video, image or other likenesses of my child for publication
purposes including, but not limited to, publicity, marketing, online instruction, research, and
promotion of the Urban League of Rochester, NY, Inc. and its various programs.
URBAN LEAGUE AFTERSCHOOL ACADEMY REQUIREMENTS FOR
STUDENTS:
Will follow the attendance policy as outlined by staff and programmatic requirements
Will attend all scheduled events, activities, and classes on time
3. Will be respectful toward adults and fellow students
4. Will be responsible in terms of assignments and activities
5. Will be responsible in the use of the Internet
6. Will not engage in conduct that is harmful to others, the Urban League, or other property
PARENTS/LEGAL GUARDIANS, PLEASE NOTE THAT THIS PROGRAM IS DESIGNED TO PROMOTE
SCHOOL RETENTION, ACADEMIC ACCOMPLISHMENT, SOCIAL DEVELOPMENT, AND CULTURAL
AWARENESS.
To be signed by Parent/Guardian and Student:
__________________________________________
Parent’s/Guardian’s Signature
Date
___________________
_________________________________________
Student’s Signature Date
___________________
Empowering Communities. Changing Lives.
Page 6
Urban League of Rochester, NY, Inc.
Afterschool Academy/Project Ready PSS STEM
Student Recommendation Form
Name of Student _______________________________________________ Current grade level ________________
Name of Recommender __________________________________________________________________________
Recommender’s Title ____________________________________________________________________________
Purpose: We appreciate your cooperation in completing this form. Please be candid about this student’s academic ability and
motivation. We understand the difficulty in evaluating a student and are fully aware that children are constantly growing,
changing and developing. This form is only one piece of the student’s profile to be used in our assessment process.
Thank you for your thoughtful attention to this request.
Please mark accordingly:
5) Outstanding 4) Above Average 3) Average 2) Fair 1) Needs Improvement
CHARCTER, PERSONALITY, &
ACADEMIC TRAITS
5
4
3
2
1
No basis for
judgment
Academic achievement
Academic potential
Attendance
Conduct
Efforts/initiative
Interaction with teachers/adults
Leadership
Level of engagement
Maturity
Personal integrity
Respect for others
Self-confidence
Sense of responsibility
Social relationship with peers
Indicate strength of your overall endorsement by checking the appropriate box:
[__] Highly Recommended
[__] Recommended
[__] Recommended with Reservation
[__] Not Recommended
Comments
Urban League of Rochester, NY, Inc.
Afterschool Academy/Project Ready
Student Recommendation Form
Below, please write additional comments that will aid in assessing the student’s qualifications. Use an additional sheet
if needed.
______________________________________
Signature of Recommender
________________________________
Date
______________________________________
Address
________________________________
City/State/Zip
______________________________________
Phone
________________________________
Email
Please return the completed form to:
Afterschool Academy Office
Urban League of Rochester
265 North Clinton Avenue
Rochester, NY 14605
Fax: (585) 325 – 4864