After-School Program Application

After-School Program Application

The United Crescent Hill Ministries United Learning Youth After-school Program is a partnership between youth, their families, their schools, and our staff and volunteers. Together, we encourage students’ mental, physical and emotional well-being and growth throughout the school year. The overarching goal of the United Learning program is to help students achieve academic success and develop positive behaviors and relationships with peers and adults.

The United Learning program offers a safe and supportive environment where a child can work on his/her homework and school assignments with supervision and assistance. In addition, we provide opportunities for youth to expand their skills and knowledge, build confidence,  and develop positive social and emotional learning skills.

During the school year, UCHM uses peer tutors to work with the youth in addition to staff and adult volunteers. Each peer tutor is at least three grades ahead of any child the tutor helps. The peer tutors are excellent students who have been interviewed by our staff and approved to volunteer in our program for a designated time period. UCHM also utilizes adult volunteers to assist students with homework help as well as provide assistance with general program activities. All volunteers are screened during a background check and provided training.

Our expectations for participation in the United Learning program require that together we will:

  • Set specific goals and action steps for each school year. These will be signed by all of us as our pledge to be respectful of each other and steadfast in our commitment to work to address the needs of the youth in the program.
  • Review the student’s progress reports so we can all be aware of how he/she is doing and make any needed changes in the plans to help the student to be successful.
  • Share with each other any information available from school, self-disclosure, observation, or other resources that would enable a better understanding of the student’s capabilities, progress and needs.
  • Follow the expectations, set by UCHM staff and students, at all times. Together, we will develop these expectations the first week of the program. 

UCHM’s United Learning program serves Kindergarten – Eighth Grade (K-8) children and operates from 3:00pm – 6:00pm on afternoons when school is in session.  For the  2018-2019 school year, the United Learning program will begin on Monday, August 20th and follow the Jefferson County Public School schedule for closings and holidays. UCHM’s program is not a “drop-in” program; children must be pre-registered to participate.   Please contact Katie Litanga at 893-0346. You can also email Katie at klitanga@uchmlouky.org.

The fee for the United Learning program is $25/week per child. However, we will never turn a family away from this program for inability to pay, and we offer financial aid to those who request assistance. To apply for financial assistance, please indicate that you would like to apply in your application. 

UCHM After-School Program Application

Parent/Guardian Information

Street Address/City/Zip

Student Information

Medical Information

Please provide a copy of your child's insurance card to UCHM prior to the start of the program.
If not, contact Program Director as soon as possible

Emergency Contacts and Authorized Persons

List name, phone number, and relationship to child

Financial Information

The fee for the United Learning program is $25/week. Please select a payment preference below.

Consent

In the event that my child becomes ill or sustains any injury while attending the youth program at UCHM and/or while on an authorized and chaperoned activity sponsored by UCHM (on or off UCHM property), I, the undersigned, give my permission to the adult leader(s) to administer first aid and/or CPR and to select a physician and/or hospital for my child’s care, releasing her/him from liability for their actions. UCHM Youth Program Staff are CPR/First Aid Certified. Also, I give the emergency care personnel, physicians, and/or hospital my permission to examine, treat, and provide medical, dental, or surgical diagnoses for my child. They may also x-ray, administer medication or anesthesia as deemed necessary. Further I give EMS and any other emergency transportation service my permission to transport my child. I understand that this consent and release will apply to all emergency situations present and future.
I also give permission for my child to go on any UCHM sanctioned field trip. I understand that a copy of this form, after signed, is as valid as the original. This consent/release form shall remain in effect until written revocation to UCHM or until 18 months after date signed.
I give permission for my child’s picture to be taken and used in UCHM’s newsletter, social media, or other publicity materials. UCHM will not give children’s names or any identifying information within any agency publication. Pictures will be used to share the work of UCHM with the community, donors, and supporters.
The Program Director will contact you to complete the application for financial asssitance.
Please enter your e-mail so we can send a you confirmation that we have received your application.