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2020-2021 Scholar Application

YMWIC 2018-19 PROGRAM YEAR SCHOLAR APPLICATION and GRADE REQUEST FORM
Please complete one application for each scholar, including school and grade information for the 2020-2021 school year.

Complete una solicitud por cada estudiante, incluida la información de la escuela y el grado para el año escolar 2020-2021.

All information provided in this form is accessed only by authorized employees of YMWIC Foundation and is held confidentially.

Toda información en este formulario es accedido solamente por empleados autorizados de la fundación YMWIC y permanecen confidenciales.

The information provided on this form is true and accurate.

La información provista en este formulario es verdadera y precisa.

Check all that apply. *
Check the school district which you live in or near.
Compruebe el distrito escolar en el que vive o cerca. *

SCHOLAR Information (only)
Información del Estudiante (solamente)

T-Shirt Size *

Primary PARENT/GUARDIAN Information
( Información de Padre Primario/Guardian)

Family Information: (last 6 month’s Income)

Secondary PARENT/GUARDIAN Information
(Información de Padre Secundario/Guardian)

All information provided in this form is accessed only by authorized employees of YMWIC Foundation and is held confidentially.
Toda información en este formulario es accedido solamente por empleados autorizados de la fundación YMWIC y permanecen confidenciales.

For After School Scholarship Program

Parents, please read the information below carefully; and provide your signature, indicating that you understand and agree that:
(Padres favor de leer la información siguiente cuidadosamente y provean su firme indicando que entienden y están de acuerdo con:

  1. I may choose to provide a PDF or paper copy of my child’s grades.
    Puedes elegir proveer un PDF ó copia impresa de las calificaciones de su estudiante.
  2. I will fulfill requests made for grades and/or academic reports made regarding my student within one week of request or marking period ending.
    Se le requiere cumplir con la solicitud de calificaciones del estudiante entre una semana de la solicitud ó terminación del período de notas.
  3. My scholar will participate in at least 80% or 14 of the workshops.
    Mi estudiante debe participar por lo menos en 80% de los talleres.
  4. My scholar will participate in at least two of the community service experiences.
    Mi estudiante debe participar por lo menos en 2 actividades de servicio comunitario.
  5. My scholar will maintain grades ABOVE 78% in Math, Science and ELA.
    Mi estudiante debe mantener sus calificaciones sobre un 78% en matematicas, ciencia e inglés.
  6. My scholar will attend tutoring when grades fall below 78%.
    Mi estudiante debe asistir a tutorial cuando las calificaciones están bajo el 78%
  7. I will submit a “Special Circumstances” form for any missed workshop, activity or tutoring at least 48 hours prior to the event.
    Yo presentaré la forma de “circumstancias especiales” 48 horas antes si no atendemos a un taller, o actividad de tutorial
  8. I give permission for my daughter/son to participate in all activities of YMWIC, YMWIC TANF and/or YMWIC Upward Bound Program.
    Doy permiso para que mi hija/hijo participe en todas las actividades del programa de YMWIC y/o YMWIC Upward Bound.
  9. I will provide additional documentation as requested, if my Scholar qualifies or benefits from YMWIC’s county or state grants.
    Proporcionaré documentación adicional según se solicite, si mi becario califica o se beneficia de las subvenciones estatales o del condado de YMWIC.

I understand that an unwillingness to follow the required academic curriculum may result in program dismissal.
Entiendo que una falta de voluntad para seguir el currículo académico requerido puede resultar en el despido del programa.

Please submit a copy of Scholar's:

  • Birth Certificate
  • 4th Marking Period Report Card
  • IEP (if applicable)

Parent Agreement

I permit YMWIC to place photos of my Scholar in its e-newsletter or website.

to provide YMWIC with all academic records during the current program year. I give the school permission to communicate with YMWIC on my child’s behalf. I am aware that YMWIC will work under my advisement with the school and counselor to support her/his academic progress.

I am aware that YMWIC requires all report cards and interim progress reports for each marking period.

Yo (Nombre de Padre) ____________________, autorizo (Nombre de Escuela) ____________________y al consejero de mi hijo(a) (Nombre) ____________________ a proveerle a YMWIC con todo los records académicos durante el año del programa 2019-2020. Yo le doy permiso a la escuela a comunicarse con YMWIC departe de mi hijo(a). Estoy consciente que YMWIC trabajará bajo mi guía con la escuela y el consejero para apoyar su progreso académico.

Estoy consciente que YMWIC requiere toda calificación y reportes de progreso de cada período de notas.

YMWIC’s mission is to empower and prepare youth to excel and become leaders in STEM. To this end, YMWIC monitors the academic progress of each scholar to ensure they are meeting or exceeding the requirements. Therefore, the undersigned parent/guardian of the scholar listed below authorizes the release of all grades and/or academic-related information to YMWIC Foundation, Inc., for the 2020-2021 school year.
La misión de YMWIC habilitar y preparar a jóvenes a ser líderes en STEM. Con este fin YMWIC monitorea el progreso académico de cada estudiante para asegurarnos que están cumpliendo con los requisitos de la fundación; por ende, el padre/guardián del estudiante mencionado abajo autoriza que se provean todas las calificaciones y/o información académica a YMWIC Foundation, Inc. para el año 2020-2021.

Application


APPLICATION CERTIFICATION

I certify that the information provided is true to the best of my knowledge. I am also aware that the information I have provided is subject to review and verification, (including wage records and unemployment compensation information), and that I may have to provide documents to support this application. I am also aware that my membership is subject to immediate termination if I am found ineligible after enrollment and may be prosecuted for fraud or perjury. I allow release of this information for verification purposes and understand that it will be used to determine eligibility.
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