Join the Future Inspired Native American Leaders!

Transcription

1 Join the Future Inspired Native American Leaders! What is it? An exciting program that prepares American Indian high school youth to become college and career ready and learn about their culture! Who is eligible? All American Indian or Alaskan Native high school students attending high school within Maricopa County, Salt River Pima Maricopa Indian Community Why should I participate? You will learn about college and career opportunities, how to become successful in your personal life, participate in native sports and games, and build relationships with other young native youth and community leaders! What will I do? Develop relationships with other American Indian young people Participate in a two week career exploration summer program to explore different job sites throughout Arizona, learn about your skills, and begin to find out what career interests you. Attend Monthly Saturday Academies to learn about college and career readiness, culture as a strength, personal development, and health and wellness. Participate in additional activities throughout the month related to college, careers, and culture. Receive mentoring and direct access to valuable services for you and your family. Register today! 1. Fill out the attached consent forms. 2. Return packet to the Phoenix Indian Center either by mail, fax, or attachment. Phoenix Indian Center 4520 N Central Ave, Suite 250 Phoenix, AZ Phone: , ext Fax: youthprograms@phxindcenter.org Page 1

2 Dear Future Participant and Family, The Phoenix Indian Center would like to invite you to participate in an exciting program, Forward Promise: Future Inspired Native American Leaders A College & Career Readiness Program, designed for American Indian high school young people in Maricopa County. This program prepares American Indian youth to become college and career ready. We have a strong team collaborating to develop this program that includes the Phoenix Indian Center, Phoenix Union High School District, Mesa Public Schools, Native American Connections, and Native Health. The program consists of a two week Summer Career Exploration Academy, monthly Saturday Academies, and multiple events throughout the month focused on college, careers, culture, personal development, and health and wellness. Students will also receive mentoring and support from the staff at the Phoenix Indian Center. Join our program. Your opinions and ideas are vital in helping us build and expand this important program! To enroll in this FREE year-round program, please sign and complete the attached form and return it immediately. Applications are accepted on a rolling basis year-round. Program capacity is limited to 150 American Indian youth. Completed applications will be accepted on a first come, first served basis. NOTE: Upon receiving your application, a staff member from the Phoenix Indian Center will contact you regarding your enrollment. We look forward to seeing you soon! Thank you, Kalah Polsean Youth Development Specialist Phoenix Indian Center ext youthprograms@phxindcenter.org Page 2

3 Future Inspired Native American Leaders Program Student Programs Summer Career Exploration Academy July 20 th -24 th and July 27 th -31 st from 9am-1pm Two-week summer program designed to start the program year Students will learn more about themselves, their peers, culture, and be exposed to careers through job site visits to employers Saturday Academies Second Saturday of each month (September through May) Monthly event for all students focused on culture, college, and careers. Students will learn more about their identity as an American Indian and how that impacts their future college and career goals. Native Sports & Games Third Saturday of each month (October through April) Monthly event for all students to learn about Native sports and games, health and wellness, and participate in physical activity. Students will learn about Native sports and games from many tribes, history of the sport/game, and play the sport/game together. Special Events Three special events per month (September through May) Special events that vary each month to expose students to college, career, culture, and personal development. Students will experience college tours, cultural trips, job site visits, volunteer projects, college fairs, community events, and more. Individual and Small Group Mentoring Monthly meeting based on schedule and availability (September through April) Individual and small group mentoring with a Phoenix Indian Center staff member. Students will discuss grade-level appropriate college and career readiness topics, create a personal portfolio, and receive individual assistance and support. Page 3

4 Future Inspired Native American Leaders Program Parent/Guardian & Family Programs Parent/Guardian Saturday Academies Quarterly Parent/Guardian Saturday Academies (September, November, February, May) Quarterly event for parents/guardians focused on college, careers, culture, and prevention. Parents/Guardians will learn how to support and assist their students through the college and career process and how to prevent risk-behaviors. Family Native Sports & Games Third Saturday Quarterly Quarterly event for families to learn about Native sports and games, health and wellness, and participate in physical activity. Families will learn about Native sports and games from many tribes, history of the sport/game, and play the sport/game together. Special Family Events One special event per month (September through May) Special events throughout the year to expose families to college, career, culture, and personal development. Families will have the opportunity to participate in events such as college fairs, community presentations, and more together. Page 4

5 Future Inspired Native American Leaders Student Schedule* July th & July st 9:00 AM- 1:00 PM Summer Career Exploration Academy August 8 th 9:00 AM -1:00 PM Saturday Academy September 12 th 9:00 AM 1:00 PM Saturday Academy October 10 th 9:00 AM 1:00 PM Saturday Academy November 14 th 9:00 AM 1:00 PM Saturday Academy December 12 th 9:00 AM 1:00 PM Saturday Academy January 9 th 9:00 AM 1:00 PM Saturday Academy Feb 13 th 9:00 AM 1:00 PM Saturday Academy March 12 th 9:00 AM 1:00 PM Saturday Academy April 9 th 9:00 AM 1:00 PM Saturday Academy May 14 th 9:00 AM 1:00 PM Saturday Academy June 11 th 9:00 AM 1:00 PM Saturday Academy & Family Celebration Parent/Guardian Schedule* July 31 st 12:00PM- 1:00PM Future Inspired Native American Leaders Induction Ceremony August 8 th 9:00 AM -1:00 PM Saturday Academy November 14 th 9:00 AM 1:00 PM Saturday Academy Feb 13 th 9:00 AM 1:00 PM Saturday Academy May 14 th 9:00 AM 1:00 PM Saturday Academy June 11 th 9:00 AM 1:00 PM Saturday Academy & Family Celebration Events will be held at the Phoenix Indian Center 4520 N. Central Ave. Phoenix, AZ Breakfast, lunch, and transportation (upon request) are provided for students. *All dates and times are tentative and subject to change Page 5

6 Future Inspired Native American Leaders Application Checklist Complete the following forms to enroll in the Future Inspired Native American Leaders Program. o Registration Form (Page 7&8) o Phoenix Indian Center Photo / Video / Audio / Written Information Release (Page 9) o Evaluation Permission Form (Page 10) o Transcript and Student Records Release Request (Page 11&12) Return packet to the Phoenix Indian Center by mail, fax, attachment, or in-person. Phoenix Indian Center 4520 N Central Ave, Suite 250 Phoenix, AZ Fax: youthprograms@phxindcenter.org Applications are accepted on a rolling basis year-round. A limited number of spaces are available! Enroll today! Page 6

7 Future Inspired Native American Leaders Registration Form Student Contact Information Student Name: Grade: Gender: School: School District: Phone Number: Home Address: Tribal Affiliation: Parent/Guardian Contact Information Parent/Guardian Name: Parent/Guardian Relationship to Student: Phone Number: Emergency Contact/ Medical Information Hospital/Clinic Preference: Physician s Name: Phone: Allergies/Special Health Considerations: Please initial next to each statement below I hereby authorize and give full consent to the PHOENIX INDIAN CENTER, INC. to transport my child. This Release, Indemnity, and Assumption of Risk statement covers all activities, events, sessions, meals, occurrences, participation, observation, and travel between activities, associated with this project. I hereby give permission for my child to participate. For my child, I agree to assume the risk of any events associated with my child s participation, observation, or other activities that may result in any harm, injury, illness, damage or loss to my child. I hereby release, waive, and hold harmless Phoenix Indian Center, or other organizations involved in the program or any of these organizations agents, personnel or volunteers from any claims, liability, or responsibility for any such injury, illness, damage or loss. I understand the activities are voluntary, and I agree to accept the responsibility for my child s personal safety and participation in the program. I consent to the provision of emergency medical treatment for my child to the extent the treatment is necessary in the medical opinion of the doctor rendering the treatment. If I have any concerns about my child s ability to participate in any event or activity associated with the Phoenix Indian Center, I agree to discuss my concerns with my child s physician before signing this form. Continue to back page Page 7

8 Future Inspired Native American Leaders Registration Form (continued) Please initial next to each statement below Phoenix Indian Center Staff Responsibilities Explanation of available program activities to eligible participants Assistance with developing goals for eligible participants Education, advisement and assistance to achieve program goals as identified Referral for outside services not provided by program/agency Coordination of services with other agencies related to participant s progress Program Participant Responsibilities Showing up on-time for all schedules activities/events/classes. For any activity with a stipend attached (such as the Summer Career Exploration Academy), any time or days missed during the program will result in a decrease in the stipend amount. Notifying staff when you will be late or absent from any scheduled class of activity Informing staff of contact information changes as well as concerns related to the program or activities; e.g. transportation, housing, personal issues, etc. Agreeing to abide by all rules and standards, established by the Phoenix Indian Center Inc. (e.g. no smoking in the building, inappropriate language, improper use of equipment, no drugs, alcohol, and firearms allowed on the premises.) This agreement will remain in effect for the duration of the program. The Program Manager will be advised of any violations of agreement and appropriate action may be taken to remedy the situation, including family discussions or possible suspension from the program. I have read and understand the terms and conditions of this registration form and further understand my responsibilities as a program participant. I understand this authorization shall be in effect for the direction of my acceptance and participation in the program. By signing below, you indicate that you want to participate in this exciting program and that your parent/guardian supports your participation. Printed Name of Student Printed Name of Parent/Guardian Signature of Student Date Signature of Parent/Guardian Date Mail, Fax or completed form immediately. Upon receipt of form you will be contacted for the next steps. Page 8

9 PHOENIX INDIAN CENTER, INC. Photo / Video / Audio / Written information Release I hereby authorize and give full consent to PHOENIX INDIAN CENTER, INC. to reproduce, publish, display and/or copyright all written information, live broadcasts, still or motion photographs/videos and/or voice recordings taken by them or agents, in which I appear. I release PHOENIX INDIAN CENTER, INC. and its funders, representatives and assignees from any and all claims, demands and causes of action of every nature and kind arising out of or connected with the use of these broadcasts, photographs, videos and/or voice recordings. I further agree that PHOENIX INDIAN CENTER, INC. may use or cause to be used, these items for any and all exhibitions, public display, publications, commercial art and advertising purposes without limitation or reservation or any fee. Student Information Signed: Date: Print Name: Address: Phone: If person signing is a minor, legal guardian must sign below: Parent/Legal Guardian: Date: Print Name: Address: Phone: Mail, Fax or completed form immediately. Upon receipt of form you will be contacted for the next steps. Page 9

10 Future Inspired Native American Leaders Evaluation Permission Form Dear Parent/Guardian: As you know, your child is participating in the Forward Promise: Future Inspired Native American Leaders. An external evaluation of the program will be conducted to better understand the program s impact on helping young people prepare for college and careers. Here is a summary of the type of data that will be collected as part of the evaluation process: 1.) Satisfaction feedback on events attended 2.) Student information (grade, age, tribal affiliation, educational aspirations, and school data) 3.) Specific college and career readiness knowledge and skills In addition, group interviews with students will be conducted to get a better sense of their opinions of the program. All student data results are confidential, and reports of the study will not include the names or any personally identifying information of any child. Participation in the evaluation is completely voluntary. Student s Name: I understand the scope of this project and give my consent for my child to complete the project surveys throughout the year. I understand the scope of this project and do not give my consent for my child to complete the project surveys throughout the year. Parent Signature: Parent Printed Name: Date: Mail, Fax or completed form immediately. Upon receipt of form you will be contacted for the next steps. Page 10

11 Transcript/Student Records Request Form STUDENT INFORMATION First Name*: Middle Name: Last Name Date of Birth (MM/DD/YYYY)*: School ID (if known): What district and high school is this request regarding?* Please note the school district and the high school the student graduated from or last high school attended District: High School: Last Year Attendedl: Records Requested: Unofficial Transcript (Quantity: 1 ) Attendance Report Disciplinary Records 3 rd PARTY REQUESTOR CONTACT INFORMATION - Full Name Phone Number: Requestor s Signature: Date: How do you want the student records delivered?* Mail it to Phoenix Indian Center, Inc. Attn: Kalah Polsean, Youth Development Specialist Street Address: 4520 N. Central Ave. Suite 250 City, State, Zip: Phoenix, AZ Continue to back page. Page 11

12 Date: TO: From: Subject: Transcript /Student Records Request: Student Name This is to authorize the following records to be shared with authorized recipients of the Phoenix Indian Center: Records Requested: Unofficial Transcript (Quantity: 1 ) Attendance Report Disciplinary Records PARTY OR CLASS OF PARTIES TO WHOM DISCLOSURE OF RECORDS MAY BE MADE, AUTHORIZED RECIPIENT(S) : Phoenix Indian Center: 4520 N. Central Ave. Suite 250 Phoenix, AZ Chief Executive Officer Chief Operations Officer Program Managers Youth Development Specialists PURPOSE OF THE DISCLOSURE: Evaluation of the Forward Promise: Future Inspired Native American Leaders, a College and Career Readiness Program By presenting a signed and dated copy of this consent to parent/guardian and student consent to the release of records by (School District), the District) to the authorized recipient(s) for the purpose identified above. The parent and student further agree that school district authorized representatives may discuss the information contained in the records with the authorized recipients. This consent applies to educational records that may otherwise be protected under the Family Educational Rights and Privacy Act of 1974, as amended, 20 U.S.C. 1232g. (School PARENT/GUARDIAN SIGNATURE: DATE: STUDENT SIGNATURE: DATE: Mail, Fax or completed form immediately. Upon receipt of form you will be contacted for the next steps. Page 12