Urban Prep Charter Academy for Young Men Application Interest Form (for students entering 9th grade in fall 2018)
Enrollment Information
Campus of Interest (check all that apply) *
Required
Student Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Current school you attend *
Your answer
Do you have a sibling/brother currently enrolled at Urban Prep? *
Required
If "Yes", please enter his name and select the campus he attends.
Your answer
Parent or Guardian Information
For this section, please list ONE parent/guardian who should be the primary point of contact regarding this student’s application. Upon enrollment at Urban Prep, there will be an opportunity for you to add other parents/guardians to the students file.
Honorific *
First Name *
Your answer
Last Name *
Your answer
Relationship To Applicant *
Home Address *
Your answer
Unit/Apt. #
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell/Mobile Phone Number *
(xxx-xxx-xxxx)
Your answer
Home Phone Number
(xxx-xxx-xxxx)
Your answer
Email Address *
Your answer
How did you hear about Urban Prep (CHECK ALL THAT APPLY) *
Required
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