Chicago Youth Centers
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Bridgeport, Ages 5-18
Bronzeville, Ages 5-18
Humboldt Park, Ages 15 Months-5 Years
North Lawndale, Ages 3-18
Riverdale/Altgeld Gardens, Ages 15 months-5 years
South Shore, Ages 15 months-18 years
Calumet Heights, Ages 15 Months - 18 Years Old
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Enroll Today
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Home
/
About
/
Mission
History
Impact
CYC Boards
Our Team
Financials & Non-Profit Information
Media
Stories of Possibility
Programs
/
Early Learning
Out-of-School Time (OST)
Family Engagement
Education Support Initiative
CYC Centers in Schools - 21st AVE
Communities
/
Map
Bridgeport, Ages 5-18
Bronzeville, Ages 5-18
Humboldt Park, Ages 15 Months-5 Years
North Lawndale, Ages 3-18
Riverdale/Altgeld Gardens, Ages 15 months-5 years
South Shore, Ages 15 months-18 years
Calumet Heights, Ages 15 Months - 18 Years Old
Join Us
/
Ways to Give
Enroll Today
Events
Volunteer
Careers
Consultants
Auxiliary Board
Local Advisory Boards
Donate Now
/
Where Possibility Lives
21st AVE Application
Home
/
About
/
Mission
History
Impact
CYC Boards
Our Team
Financials & Non-Profit Information
Media
Stories of Possibility
Programs
/
Early Learning
Out-of-School Time (OST)
Family Engagement
Education Support Initiative
CYC Centers in Schools - 21st AVE
Communities
/
Map
Bridgeport, Ages 5-18
Bronzeville, Ages 5-18
Humboldt Park, Ages 15 Months-5 Years
North Lawndale, Ages 3-18
Riverdale/Altgeld Gardens, Ages 15 months-5 years
South Shore, Ages 15 months-18 years
Calumet Heights, Ages 15 Months - 18 Years Old
Join Us
/
Ways to Give
Enroll Today
Events
Volunteer
Careers
Consultants
Auxiliary Board
Local Advisory Boards
Donate Now
/
School Partnership Interest Form
School Name
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Neighborhood
*
Principal Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Additional Staff Contact
First Name
Last Name
Title
Email
Phone
(###)
###
####
School Start Time
*
Hour
Minute
Second
AM
PM
School End Time
*
Hour
Minute
Second
AM
PM
1. How many students does your school serve overall?
*
2. What is your enrollment by grade level?
*
Ex. Grade K: X Enrolled Grade 1: X Enrolled etc. through Grade 12
3. Please provide an ethnicity breakdown:
*
Ex. X% White X% African American X% Hispanic X% Native American X% Asian X% Other
4. Languages spoken (Percentage of total # of students):
*
Ex. X% English only X% English and Spanish X% Spanish only X% Other (Specify)
5. What percentage of students come from CHA households?:
*
6. What percentage of students receive free or reduced lunch?
*
7. Proposed number of students you want CYC's 21st AVE program to serve (up to 100):
*
8. For which grade levels do you hope to offer 21st AVE afterschool programs? (Check all that apply):
*
K
1
2
3
4
5
6
7
8
9
10
11
12
9. Preferred start date:
*
MM
DD
YYYY
10. Preferred end date:
*
MM
DD
YYYY
11. At what time do you prefer your 21st AVE program to begin?
*
Hour
Minute
Second
AM
PM
12. Which day(s) do you prefer your 21st AVE program to operate? (Check all that apply):
*
Monday
Tuesday
Wednesday
Thursday
Friday
13. When would you prefer your 21st AVE program to operate? (Check all that apply):
*
School year only
School year and summer
14. Will you assist with providing access to participating students' grades and attendance data (for students whose parents sign a release)?
*
Yes
No
Other
If you selected other, please clarify:
15. Is there a desk, storage space, and telephone available for onsite staff?
*
Yes
No
16. Do you have available classrooms/meeting space for programming?
*
Yes
No
17. Will security be provided for afterschool programs?
*
Yes
No
18. Are you comfortable with your parents paying a fee for an afterschool program?
*
Yes
No
Other
If you selected other, please clarify:
19. What is the fee range per session that you believe is feasible for your parents (assuming that there are three session blocks during the school year)?:
*
20. CYC's 21st AVE operates with a cost-sharing model, with each school partner contributing a distinct amount toward the overall cost annually. Are you comfortable with this, knowing the shared amount will need to be determined via a follow-up conversation, and is based on multiple factors including overall need, ability to co-fundraise, and available state funding sources?
*
Yes
No
Other
If you selected other, please clarify:
21. To help assess funding needs, how much financial support can your school contribute toward a cost-sharing program model?
*
22. Are you interested in Family Engagement activities?
*
Yes
No
If you selected yes, please describe what you're most interested in for parents:
23. Please select which activities you might like to have at your school during afterschool:
Academic tutoring
Homework help
Social-emotional learning
Mentoring
STEM/STEAM
Dance
Music
Martial arts
Chess
Gaming
Volleyball
Non-contact boxing
Puppet making
Knitting
Technology
Basketball
Cheerleading
Soccer
Culinary
Web design
Gardening
Choir
Fashion design
Cosmetology
Debate
Financial literacy
Spoken word
Drama
Rock band
Photography
Music instruments
Girl Scouts
Arts & crafts
Film
Newspaper
Book club
Movie club
Student leadership
Investment/Entrepreneurship
Baseball
Flag football
Exercise/Fitness
Other activities:
24. How would you describe the culture of your school? (Please include what you define as your current culture and your vision/expectations for the upcoming school year and beyond. Please also discuss the school morale, and if there is a particular aesthetic or values you emphasize.) We ask this question to assist us in creating and selecting the best program offerings for your school, and to choose the appropriate staff who will reflect not only CYC's 21st AVE mission, but also your school's purpose and intention.
*
25. Do you wish to provide any clarification on your answers?
26. Do you have any preliminary questions for CYC?
Principal's E-Signature:
*
Thank you! We will be in touch soon.
Home
/
About
/
Mission
History
Impact
CYC Boards
Our Team
Financials & Non-Profit Information
Media
Stories of Possibility
Programs
/
Early Learning
Out-of-School Time (OST)
Family Engagement
Education Support Initiative
CYC Centers in Schools - 21st AVE
Communities
/
Map
Bridgeport, Ages 5-18
Bronzeville, Ages 5-18
Humboldt Park, Ages 15 Months-5 Years
North Lawndale, Ages 3-18
Riverdale/Altgeld Gardens, Ages 15 months-5 years
South Shore, Ages 15 months-18 years
Calumet Heights, Ages 15 Months - 18 Years Old
Join Us
/
Ways to Give
Enroll Today
Events
Volunteer
Careers
Consultants
Auxiliary Board
Local Advisory Boards
Donate Now
/
Chicago Youth Centers
