Urban Prep Charter Academy for Young Men Electronic Application and Request for Information
To apply to Urban Prep for the Fall of 2017, please complete the following form. Applicants must be residents of the City of Chicago and remain residents throughout their enrollment with Urban Prep. Please contact our Admissions Department at 312-276-0259 ext. 1108 with questions. Thank you.

To request information about Urban Prep, please go to the following URL: http://www.urbanprep.org/about/contact-us

Enrollment Information
Grade Level Entering the Fall of 2017 (Select One) *
Required
Campus of Interest (check all that apply) *
Required
Student Information
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Phone Number
(xxx-xxx-xxxx)
Your answer
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
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
Work Phone Number
(xxx-xxx-xxxx)
Your answer
Email Address *
Your answer
How did you hear about Urban Prep *
Required
Parent Signature/Guardian Signature
By providing your electronic signature below, the student and parent confirm that the information provided on this application is true/accurate. The student and parent understand that 1) completion of this application does not guarantee admission; 2) applicant is a resident of the City of Chicago; 3) the applicant is currently enrolled in or recently completed the grade level preceding the one for which they are applying (e.g. applicants for Urban Prep’s 9th grade/Freshmen class are currently in or have recently graduated from 8th grade, transfer applicants for Urban Prep’s 10th grade/Sophomore class are currently in or recently completed the 9th grade)
Signature (type name) *
Your answer
Confirm Signature *
Required
Today's Date *
MM
/
DD
/
YYYY
Relationship To Student *
Submit
Never submit passwords through Google Forms.
This form was created inside of Urban Prep Academies. Report Abuse - Terms of Service - Additional Terms