Turning Point - Returning Student

Dear Student and Parent / Legal Guardian,

We are excited that you have made the choice to apply to Turning Point of Lansing! Our missions is to help boys transform to men with our Afrocentric programming based on the 7 principles of Kwanzaa:

NGUZO SABA (The 7 Principles)

Umoja (OO-MO-JAH) (Unity) To strive for and maintain unity in the family, community, nation, and race.

Kujichagulia (KOO-GEE-CHA-GOO-LEE-YAH) (Self-Determination) To define us, name ourselves, create for ourselves, and speak for ourselves.

Ujima (OO-GEE-MAH) (Collective Work and Responsibility) To build and maintain our community together and make our brother’s and sister’s problems our problems and to solve them together.

Ujamaa (OO-JAH-MAH) (Cooperative Economics) To build and maintain our own stores, shops, and other businesses and to profit from them together.

Nia (NEE-YAH) (Purpose) To make our collective vocation the building and developing of our community in order to restore our people to their traditional greatness.

Kuumba (KOO-OOM-BAH) (Creativity) To do always as much as we can, in the way we can, in order to leave our community more beautiful and beneficial than we inherited it.

Imani (EE-MAH-NEE) (Faith) To believe with all our heart in our people, our parents, our teachers, our leaders and the righteousness and victory of our struggle.
You will need to have BOTH Student and Parent (or Legal Guardian) available to complete this short application.

You will be asked to provide basic contact information for both Student and Parent (or Legal Guardian), academic and interest information for the Student, and at the end the Parent (or Legal Guardian) must sign a few waivers.

After that our staff will receive your application, review it, and reach out to you within 5 - 7 business days.

Again - we are excited to welcome you to our JUMUIYA (community)!

- Sincerely,

Mandeville Berry

Returning Student Application

Please allow 10-15 minutes to complete the application.
Student Contact Information
programid
Grade Number
Naming Exclusion

Household__c.Formal_Greeting__cHousehold__c.Informal_Greeting__c
Are you a new student or a returning student?*

NewReturning
Student Applicant Name*

First NameLast Name
Preferred Name
Birthdate*

MonthDayYear
Phone Number*
Please enter a valid phone number.
Personal Email
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Academic Information
Current School*
If 'Other' please enter school name here*
Current Grade*
Anticipated High School Graduation Year*
GPA*
Please enter final GPA from prior school year

More Student Information
Favorite Subjects*
Special Talents / Skills
Extracurricular Activities
Men's Shirt Size*
Plans after High School graduation*
Student Medical Information

Type 'N/A' if there isn't any information to provide in this section
List Current Medications*
List Any Known Allergies*
List Any Known Illnesses*
Health Insurance Provider and ID Number*

Guardian Name
Parent / Legal Guardian Information
Name*

First NameLast Name
Preferred Name
Date of Birth*

MonthDayYear
Date
Relation to Student*
Occupation*
Preferred Primary Contact Number

MobileHome
Mobile Number*
Please enter a valid phone number.
Home Number
*if applicable
Work Number
*if applicable
Preferred Primary Email*

PersonalWorkAlternate
Email*

Confirmation Email
Is the Parent's / Legal Guardian's address the same as the Students?*

YesNo
Primary Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this a work or home address?*

HomeWork

Releases and Commitments
How did you hear about The Turning Point of Lansing?*
MEDICAL RELEASE I give permission for the above minor to receive medical treatment in case of injury. I give permission for the aforementioned minor to participate in the upcoming events and activities sponsored by The Turning Point of Lansing. I do hereby release The Turning Point of Lansing from any and all liabilities and such personal injuries as may result directly or indirectly from any activity conducted under the supervision and direction of The Turning Point of Lansing.*

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PROGRESS INFORMATION RELEASE In connection with my student’s participation with the Turning Point of Lansing, I hereby agree as follows: I hereby authorize an official at my student’s school to disclose to The Turning Point of Lansing Representative in good faith any information they may have regarding his/her grades and educational progress. I will hold the School, any former employers, educational institutions, and any other persons giving educational information free of liability for the exchange of this information and any other reasonable and necessary information related to my student’s educational process. This Agreement is made and effective this date.*

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PHOTO RELEASE I authorize The Turning Point of Lansing to videotape and photograph my child’s, image and/or voice for use in program materials, program marketing materials and the program website. I understand and agree that these audio, video, film and/or print images may be edited, duplicated, distributed, reproduced, reformatted, and/or translated into other languages in any manner without payment of fees, in perpetuity.*

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PARENTAL COMMITMENT As the parent/legal guardian of a participant of The Turning Point of Lansing, I agree to the following:-Ensuring that the program participant abides by the guidelines and rules of The Turning Point of Lansing- Providing the guidance for program participants to make good decisions- Attending parent workshops- Ensuring submission of participant grades to the evaluation committee of The Turning Point of Lansing- Volunteering for at least one program event- Maintaining high expectations for program participants- Staying in contact with elders- Annual contribution of $20 (tax deductible) for program polo shirt***Failure to adhere to the aforementioned may cause your child to lose Turning Point of Lansing privileges and can lead to their removal from the program. During Turning Point of Lansing parent meetings, program elders will have discussions about your son’s growth and development in the program.*

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ANNUAL CONTRIBUTION $20 (tax deductible) for program polo shirt (new participant)

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STUDENT COMMITMENT As a student of The Turning Point of Lansing, I agree to the following: - Attend and actively participate in 75% of all program activities - Encourage fellow members of The Turning Point of Lansing - Abide by the guidelines and rules of The Turning Point of Lansing - Refraining from the use cell phones or other electronic devices during program sessions - Adhering to program dress code: -Wearing The Turning Point of Lansing shirt to all program events - No jeans; No sagging pants - No hats during program events unless otherwise specified - Submitting grades to elders upon receipt from school - Make good decisions and be held accountable for my choices/actions - Maintain high learning expectations for oneself ***Failure to adhere to the aforementioned can cause participants to lose Turning Point of Lansing privileges and can lead to removal from the program.*

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I certify that the information included in this application is entered is true and accurate to the best of my knowledge.*

Student - Yes, I agreeParent/Guardian - Yes, I agree
Please verify that you are human*
Submission Date

MonthDayYear
Date
Should be Empty:

Returning Student Application

Student Contact Information

Student Academic Information

More Student Information

Student Medical Information

Parent / Legal Guardian Information

Releases and Commitments