Midtown/Metro Program Application

Traducción al español está en font gris. Por favor, responda en Inglés y no use acentos ( ' ) o tildes ( ~ ).

Applicant's Sex

Sexo del estudiante: Niña o Niño

Status

NewReturningEstado: (Elija uno.) Estudiante nuevo al programa o Estudiante regresando al programa

Center

Centro: Metro para las niñas o Midtown para los niños

Scheduling Interview Information

If you are a NEW student, choose one of the following to schedule an appointment for an interview and tour at the center. Returning students do not need to interview.

Si usted es un estudiante nuevo, elija una de las fechas para hacer una cita para una entrevista y una visita. ESTUDIANTES QUE ESTAN REGRESANDO NO NECESITAN ENTREVISTAS.

If applying to Metro, please select your preferred choice.

Si aplica a Metro, por favor seleccione su fecha preferida.

Scheduling Interview Information

If you are a NEW student, choose one of the following to schedule an appointment for an interview and tour at the center. Returning students do not need to interview.

Si usted es un estudiante nuevo, elija una de las fechas para hacer una cita para una entrevista y una visita. ESTUDIANTES QUE ESTAN REGRESANDO NO NECESITAN ENTREVISTAS.

If applying to Midtown, please select your preferred choice.

Si aplica a Midtown, por favor seleccione su fecha preferida.

Traducción al español está en font gris. Por favor, responda en Inglés y no use acentos ( ' ) o tildes ( ~ ).

Please indicate how you heard about us here:

Si es nuevo, ¿cómo nos ha conocido?:

If you marked OTHER, please explain here. Or, if you marked MIDTOWN/METRO PARENT or FRIEND/COLLEAGUE, please provide his/her name here:

Si marcó OTRO , explique aquí cómo o si marcó PADRE DE MIDTOWN O METRO o AMIGO/COMPAÑERO DE TRABAJO, indique su nombre aquí:

At what grade did the student first start attending our programs?

¿En qué grado comenzó el alumno a asistir a nuestros programas?

Program Term Selection

Summer 2025School Year 2024-2025Seleccione la sesión del programa: Año escolar 2024-2025 o Verano 2024

ATTENTION:

Our Summer 2024 application is officially closed. Please email Mr. Dancer at enroll@midtown-metro.org or call 773-292-2660 ext. 222, as soon as possible, to inquire about any remaining space to enroll your child(ren) into our programs.

ATTENTION:

Our Summer 2025 application is not yet open to new families. If you would like to be contacted when it is available or have questions, please complete an interest form.

Grade *If applying for the SCHOOL YEAR, list your grade for 2024-2025. If applying for the SUMMER, put the grade you will be next Fall (2025-2026).

Si va a aplicar para el año escolar, indique su grado actual. Si va a aplicar para el verano, indique en que grado estará en el otoño. (Elija uno.)

Program (based on your child's grade level)

Programa (basado en su grado): ONE (Cuarto a sexto grados), MAP (Séptimo a octavo grados), COP (Noveno a duodécimo grados)

Metro ONE School Year Program Specifics: Tuesdays or Thursdays.

3rd-5th graders - Tuesdays3rd-5th graders - Thursdays

Metro ONE Summer Program Specifics (3rd-5th grade):

Six Week Session (June 17th- July 25th)

Metro MAP School Year Program Specifics: Tuesdays or Wednesdays (academic readiness and character education).

6th-8th graders - Tuesdays 6th-8th graders - Wednesdays

Metro MAP Summer Program Specifics (6th, 7th, 8th grade):

Six Week Session (June 17th- July 25th)

Metro COP School Year Program Specifics: Wednesdays or Thursdays

9th - 12th graders - Wednesdays9th - 12th graders - Thursdays

Metro COP Summer Program Specifics (9th Grade) - Selection 1 (Students can participate in up to all three sessions; you will be able to make additional selections below):

Leadership and Service (June 20th- June 30th)Career Exploration (July 3rd- July 14th)Writer's Workshop (July 17th- July 28th)You will be able to make additional selections below.

Metro COP Summer Program Specifics (9th Grade) - Selection 2 (Students can participate in up to all three sessions; you will be able to make additional selections below):

Leadership and Service (June 20th- June 30th)Career Exploration (July 3rd- July 14th)Writer's Workshop (July 17th- July 28th)I am not interested in selecting a second or third session

Metro COP Summer Program Specifics (9th Grade) - Selection 3 (Students can participate in up to all three sessions; you will be able to make additional selections below):

Leadership and Service (June 20th- June 30th)Career Exploration (July 3rd- July 14th)Writer's Workshop (July 17th- July 28th)I am not interested in a third session

Metro COP Summer Apprenticeship Program Specifics (9th-12th Grade): Please select your first choice Apprenticeship program.

Healthcare (June 17th - July 25th)Hospitality (June 17th - July 25th)Business (June 17th - July 25th)Engineering (June 17th - July 25th)Communications (June 17th - July 25th)

If you chose Freshman Program, you are also eligible to sign up for Service Week. Are you interested?

I'm interestedSi Ud. eligió el Programa Freshman, es también elegible para inscribirse en la Semana de Servicio. ¿Está interesado? ESTOY INTERESADO

Midtown ONE School Year Program Specifics: MONDAYS or WEDNESDAYS from 4:30-8:00 pm or SATURDAYS from 9:30am - Noon.

3rd-5th graders - Mondays3rd-5th graders - Wednesdays3rd-5th graders - Saturdays

Midtown ONE Summer Program Options (3rd-5th grade):

Six Week Session (June 17th- July 25th)

Midtown MAP School Year Program Specifics: 6th-8th grade program is MONDAYS and WEDNESDAYS from 6:00 pm-8:30 pm.

6th-8th graders - Mondays & Wednesdays

Midtown MAP Summer Program Options (6th, 7th, 8th grade):

Six Week Session (June 17th- July 25th)

Midtown COP School Year Program Specifics: Program is MONDAYS & WEDNESDAYS 4:00-7:00 pm.

9th-12th graders - Mondays & Wednesdays

Midtown COP Summer Program Options: Please select your first choice Apprenticeship program.
June 17th - July 25th.

Pre-LawConstructionArchitectureEngineeringComputer Science

Cumulative GPA (If unknown, please estimate.)

GPA acumulativo (Si no lo sabe, por favor estime.)

Metro Program Shirt Size

We cannot guarantee that we will be able to provide your size, but we will do our best to accommodate you.

ONE Shirt Size

MAP/COP Shirt Size

Midtown Program Shirt Size

We cannot guarantee that we will be able to provide your size, but we will do our best to accommodate you.

ONE Shirt Size

MAP/COP Shirt Size

ONE Elective Preferences

Electives are first-come, first-served. We will do our best to accommodate first-choice selections, but cannot make any guarantees.
Each student will participate in two Elective classes.
Program staff will confirm elective assignments prior to the program beginning.
NOTE: For the Cooking elective, a parent should be in the vicinity and a few perishable supplies may be required.

Please select your first choice for Elective classes.

Please select your second choice for Elective classes.

Please select your third choice for Elective classes.

MAP Elective Preferences

We cannot guarantee elective preferences. We will do our best to accommodate first-choice selections.
Program staff will confirm elective assignments prior to the program beginning.
NOTE: For the Cooking and Hospitality elective, a parent should be in the vicinity and a few perishable supplies may be required.

Please select your first choice for Elective classes.

Please select your second choice for Elective classes.

Please select your third choice for Elective classes.

COP Elective Preferences

All students must participate in two electives. You may participate in more, subject to availability.
We will do our best to accommodate preferences, but cannot make any guarantees.
Program staff will confirm elective assignments prior to program beginning.

Please select your first choice for Elective classes.

Please select your second choice for Elective classes.

Please select your third choice for Elective classes.

Metro COP Summer Freshman Program

8th Grade Math

8th Grade Math Letter Grade

9th Grade Math Class

9th Grade Math Class Other

Metro COP Summer Apprenticeship

Metro COP Summer Apprenticeship First Choice

Metro COP Summer Apprenticeship Second Choice

Midtown COP Student Information

The Summer Program requires a dress code -- a Midtown Polo shirt. This cost is additional to the program fee -- $10 each shirt. It is recommended that you purchase a minimum of 2 shirts.

Shirt Size

Number of Shirts

Total Shirt Cost $

Midtown COP Summer Apprenticeship Information

For which Midtown COP apprenticeship are you applying?

If you are not accepted into the apprenticeship of choice, would you be interested in Midtown placing you in another internship?

YesNo

Why do you want to participate in Midtown's apprenticeship program?

Do you feel that your grades and your marks in conduct reflect who you are?

What are your goals and aspirations after high school?

Do you feel you will be able to work well in small groups?

The Apprenticeship program requires diligent independent work. Do you feel you will be able to work well independently? What challenges do you foresee?

Are there any dates you will not be able to attend the program?

If you are not accepted into your first choice Apprenticeship program, what is your second choice?

Pre-LawConstructionArchitectureEngineeringComputer Science

What is your third choice Apprenticeship program?

Pre-LawConstructionArchitectureEngineeringComputer Science

Student Information

Por favor, responda en Inglés y no use acentos ( ' ) o tildes ( ~ ).

Nombre del estudiante: Primer nombre

Student First Name

Segundo nombre

Student Middle Name

Apellido

Student Last Name

Student Birthdate (month/day/year; use the << to navigate to the correct year, then use the < or > to go to the correct month and then click on the day)

Fecha de nacimiento (mes/dia/año; use el << para navegar al año correcto, luego use el < o > para ir al mes correcto y luego haga clic en el día)

Student Race/Ethnicity (Choose only one.)

Multi-racialAfrican American or BlackAsian or Pacific IslanderLatino or HispanicNative AmericanWhiteRaza/Etnia: (Seleccione solamente uno.) Multirracial; Afroamericano o negro; Asiatico o nativo de la Polinesia; Latino o hispano; Nativo americano; Caucásico

Student's Cell Number

Celular del estudiante: (Prefijo) Número del teléfono

Student's E-mail

Address

Domicilio: Calle, Apt o Piso

Address Line 1

Ciudad

City

State

Estado

Código postal

Postal Code

School

School Type

Tipo de escuela: (Elija uno.) Parroquial, Privado, o Público/Charter

If you are having trouble finding your parochial or private school, try looking for your school in the other list (either private or parochial).

If you are having trouble finding your public school, try looking for the school according to the last name of the person the school is named for, i.e., Washington, George or Irving, Washington.

Si tiene dificultades en encontrar su escuela parroquial o privada, trate de buscar su escuela en la otra lista (privada o parroquial).

Si tiene dificultades en encontrar su escuela pública, trate de buscar su escuela por el apellido de la persona por la cual la escuela es nombrada, por ejemplo, WASHINGTON, GEORGE o IRVING, WASHINGTON.

School Name

Nombre de su escuela parroquial:

School Name

Nombre de su escuela privada:

School Name

Nombre de su escuela pública/charter:

If school is NOT listed above, enter school name here:

Si la escuela no está en la lista anterior, introduzca el nombre aquí:

REPORT CARD: If possible, upload a copy of your most recent report card.

Si es posible, suba una copia de sus calificaciones más recientes . (Seleccione archivo.)

Sibling Information

Sibling 1

Nombre del hermano o/y hermana: Primer nombre

First Name

Apellido

Last Name

Gender

MaleFemaleGénero: Niño o Niña

Birthdate (month/day/year; use the << to navigate to the correct year, then use the < or > to go to the correct month and then click on the day)

Fecha de nacimiento 1 (mes/dia/año; use el << para navegar al año correcto, luego use el < o > para ir al mes correcto y luego haga clic en el día)

Sibling 2

Nombre del hermano o/y hermana: Primer nombre

First Name

Apellido

Last Name

Gender

MaleFemaleGénero: Niño o Niña

Birthdate (month/day/year; use the << to navigate to the correct year, then use the < or > to go to the correct month and then click on the day)

Fecha de nacimiento 2 (mes/dia/año; use el << para navegar al año correcto, luego use el < o > para ir al mes correcto y luego haga clic en el día)

Sibling 3

Nombre del hermano o/y hermana: Primer nombre

First Name

Apellido

Last Name

Gender

MaleFemaleGénero: Niño o Niña

Birthdate (month/day/year; use the << to navigate to the correct year, then use the < or > to go to the correct month and then click on the day)

Fecha de nacimiento 3 (mes/dia/año; use el << para navegar al año correcto, luego use el < o > para ir al mes correcto y luego haga clic en el día)

Primary Parent/Guardian Information

Primary Contact's Name (with whom the student lives)

Nombre del primer contacto (con quién vive el estudiante): Primer nombre

Primary Contact's First Name

Apellido

Primary Contact's Last Name

Relationship

Relación: (Elija uno) Madre, Padre, Tutor, Otro

Primary Contact's Home Number

Teléfono de la casa del primer contacto: (Prefijo) Número del teléfono

Primary Contact's Cell Number

Celular del primer contacto: (Prefijo) Número del teléfono

Preferred Phone

Número del teléfono preferido

Primary Contact's Email

Preferred Email

E-mail preferido

Primary Contact's Occupation

Ocupación

Primary Contact's Employer

Empleador

Household Information

For financial aid purposes and to facilitate communication, please fill out the following information.
The HOUSEHOLD YEARLY INCOME refers to the TOTAL COMBINED INCOME of all guardians that are working and living in the student's home. (Do not use commas within number)

NOTE: In line with our mission, low income family households will be prioritized for admission. We reserve the right to verify income before enrollment.

Household Yearly Income

(Do NOT use commas) Información del Hogar - Para propósitos de ayuda financiera y para facilitar la comunicación, por favor complete la siguiente información. Tenga en cuenta que los ingresos anuales de su hogar se refiere al TOTAL COMBINADO INGRESOS de todos los padres o tutores que trabajan y viven en la casa del estudiante. Ingreso anual familiar:

Number of Persons in the Household

Número de las personas en la casa

Primary Language Spoken at Home

Primer idioma en el hogar

Secondary Language Spoken at Home

Segundo idioma en el hogar

Secondary Contact Information

Secondary Contact's Name

Nombre del segundo contacto: Primer nombre

Secondary Contact's First Name

Apellido

Secondary Contact's Last Name

Relationship

Relación: (Elija uno) Madre, Padre, Tutor, Otro

Secondary Contact's Home Number

Teléfono de la casa del segundo contacto: (Prefijo) Número del teléfono

Secondary Contact's Cell Number

Celular del segundo contacto: (Prefijo) Número del teléfono

Secondary Contact's Email

Secondary Contact's Occupation

Ocupación

Secondary Contact's Employer

Empleador

If Address is NOT the same as the one listed above, please enter the new address here:

Secondary Contact's Address

Si domicilio no es el mismo que aparece más arriba, por favor introduzca el nuevo domicilio aquí: Calle, Apt./Piso/Unidad

Ciudad

Secondary Contact's City

Estado

Secondary Contact's State

Código postal

Secondary Contact's Postal Code

Emergency Information

Emergency's Contact Name
In the case that parent(s) and/or primary/secondary contact is not available. Emergency Contact should be different than previous listed name(s).

Emergency Contact First Name

Información de emergencia - El nombre del contacto de emergencia: Primer nombre

Emergency Contact Last Name

Apellido

Emergency Contact's Cell Number

Celular del contacto de emergencia: (Prefijo) Número del teléfono

Medical Information

Name of Health Insurance Carrier

Información médica - Nombre de la compañía de seguros de salud: (Elija uno.)

If you marked OTHER, list the name of your health insurance carrier here:

Si marcó OTRO, anote el nombre de su compañía de seguros de salud aquí:

Group Policy Number

El número de póliza de grupo

Doctor's Name

Nombre del médico. Primer nombre

Doctor's First Name

Apellido

Doctor's Last Name

Doctor's Phone Number

Teléfono del médico: (Prefijo) Número del teléfono

Doctor's Address

Domicilio del médico: Calle, Suite #/Edificio

Doctor's Address

Ciudad

Doctor's City

Estado

Doctor's State

Código postal

Doctor's Postal Code

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe. If not applicable, write NA

¿El estudiante tiene algún tipo de alergia, enfermedades crónicas o condiciones médicas? En caso afirmativo, por favor describa. En caso negativo, escriba NA.

Is the student prescribed an inhaler or any other special medications? If yes, please explain any instructions. If not applicable, write NA

¿Se le a recetado al estudiante un inhalador o otros medicamentos especiales? En caso afirmativo, explique las instrucciones. En caso negativo, escriba NA.

Informed Consent and Acknowledgement

I certify that I have read the Medical Release and Parent Authorization waiver and agree to the terms and conditions and policy guidelines for parents and students of the Midtown and Metro programs and am indicating my consent by checking the boxes below.

You can read the documents by clicking on the following hyperlinks:

Terms and Conditions
Policy Guidelines for Parents and Students

Read each section of the Terms and Conditions and the check EACH box below:

AUTHORIZATION FOR ACADEMIC REPORTSMEDICAL RELEASE WAIVERPARENT RESPONSIBILITY POLICY - 1) Mandatory attendance to one parent event 2) For students in 7th-12th grades, permission to dismiss child allowing him/her to take public transportation home without a guardian presentPOLICY GUIDELINES FOR PARENTS AND STUDENTSBy your clicking this box as your email signature, you are acknowledging that you have read, agreed to and accepted all the terms and conditions regarding your child’s attendance and participation in the programs at the Metro Achievement Center and/or Midtown Center.Consentimiento informado y reconocimiento - Certifico que he leído la Autorización Médica y la renuncia de Autorización de Padres y acepto los términos y condiciones y las directrices para los padres y estudiantes de los programas de Midtown y Metro y estoy indicando mi consentimiento marcando las casillas a continuación. (Puedes leer los Términos y Condiciones y las Directrices para los padres y estudiantes haciendo clic en los hipervínculos anteriores). AUTORIZACIÓN PARA INFORMES ACADÉMICOS, RENUNCIA DE LIBERACIÓN MÉDICA, POLÍTICA DE RESPONSABILIDAD DE LOS PADRES - 1 ) Asistencia obligatoria a un evento de los padres 2 ) Para los de grados 7-12, la autorización para despedir a los niños permitiendo que él/ella para llevar a casa el transporte público sin un tutor presente, DIRECTRICES PARA PADRES Y ESTUDIANTES, Por su clic en este cuadro como su firma de correo electrónico, usted reconoce que ha leído y aceptado todos los términos y condiciones en relación con la asistencia de su hijo y la participación en los programas en Metro Achievement Center/Midtown Center.

Contact Information