Ivy Prep Afterschool Application 2025-2026

Girls Inc. Enrichment at Ivy Prep Academy
Clearly mark in the circles beside each program to indicate which Enrichment Programs you are registering for.

You Grow Girl: 3rd–5th Grade Girls
- You Grow Girl is an academic enrichment program dedicated towards girls in third throughfifth grade. This program will take place Monday through Thursday immediately followingschool from 3:30pm to 4:30pm.
- Cost: $20 per week
Girls Leading Our World (GLOW): Kindergarten–8th Grade Girls
- GLOW is an afterschool enrichment program dedicated to all girls with an emphasis onleadership, community action, financial literacy, and celebrating the fun of just being agirl! This program will take place once a week by grade level immediately following schoolfrom 3:30pm to 5:30pm.
  - Tuesdays: K-2
  - Wednesdays: 3-5
  - Thursdays: 6-8
- Cost: $75 per semester
Please select:

You Grow Girl: 3rd – 5th Grade GirlsGirls Leading Our World (GLOW): Kindergarten – 8th Grade Girls
Girl Name
Date of Birth (MM/DD/YYYY)

MonthDayYear
Date
Age
Grade
Girl Address
Girl Career Aspirations
Dietary Restrictions/ Allergies
To help us keep these programs available, Girls Inc. must raise funds from a variety of donors. Please help us in this effort by answering the following questions. This information will only be shared as an aggregate number (i.e. 50% of girls and will NOT affect your participant’s participation in the program.
What is the ethnicity/race of the girl participating check all that apply:

Alaskan Native/ Native AmericanAfrican American/ BlackAsianCaucasian/ WhiteHawaiian/ Pacific IslanderLatino/ HispanicOther (Please Define)
If you have further questions, comments, or concerns about this application or payments, please contact Cathy Anderson, Compliance Manager at canderson@girlsincatl.org.

If you have further questions pertaining to programs, please contact Lea Christianna Nelson, Senior Program Manager at lnelson@girlsincatl.org or Shikera Cook, Youth Program Manager at scook@girlsincatl.org.
What language(s) is spoken in your home (check all that apply):

EnglishSpanishOther (Please Define)
Who lives with the participant at home check one:

Both ParentsMother OnlyFather OnlyOne Parent at a Time (Joint Custody)Neither Parent (Please Describe):
Is anyone in your household currently incarcerated?

YesNo
Is the Head of Household a female (check one):

YesNo
Is someone in the household currently receiving (check all that apply):

Food StampsTANFMedicaidSSDISSIFree/Reduced School Lunch
Please provide your income level

$0 - $10,000$10,001 - $20,000$20,001 – 30,000$30,001 - $50,000$50,000+
How did you hear about Girls Inc.?
I, the undersigned, certify that the information shown above is true and accurate to the best of my knowledge. I understand that I may be subject to criminal prosecution for knowingly providing false information to the agency. I also agree to provide Girls Inc. with my participant’s school information which includes academic, attendance, and behavior records.
Signature

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Date

MonthDayYear
Date
If you have further questions, comments, or concerns about this application or payments, please contact Cathy Anderson, Compliance Manager at canderson@girlsincatl.org.

If you have further questions pertaining to programs, please contact Lea Christianna Nelson, Senior Program Manager at lnelson@girlsincatl.org or Shikera Cook, Youth Program Manager at scook@girlsincatl.org.
Girls Inc. Girl Media Release
I understand that staff will keep information disclosed in the course of this program confidential unless they feel it needs to be reported to the school or other agencies to protect the safety and best interest of the participant or those around the participant.

I give permission for my girl to be photographed and for those pictures or materials she creates to be used for marketing purposes of Girls Inc. and their partners. I also give permission for my girl to participate in evaluations as part of the Girls Inc. program including pre-and post-program surveys.
Girl Name
Parent/Guardian Name
Signature

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Date

MonthDayYear
Date
Girls Inc. would like to stay in contact with you and your child for the purposes of involving you in future programming opportunities. Including our annual scholarships awarded exclusively for participants who have gone through our programs and special field trips, workshops and future programs. In addition, we hope to stay in touch to see how Girls Inc. girls succeed in the future!

The information you provide will not be used by anyone outside of Girls Inc.

If you have further questions, comments, or concerns about this application or payments, please contact Cathy Anderson, Compliance Manager at canderson@girlsincatl.org.

If you have further questions pertaining to programs, please contact Lea Christianna Nelson, Senior Program Manager at lnelson@girlsincatl.org or Shikera Cook, Youth Program Manager at scook@girlsincatl.org.
Parent/Guardian Contact Information
Full Name*
Relationship to Applicant*
Cell Phone*
Work Phone*
Email*
example@example.com
Emergency Contact Information
Full Name*
Relationship to Applicant*
Cell Phone*
Work Phone*
Email*
example@example.com
Emergency Contact Information
Full Name*
Relationship to Applicant*
Cell Phone*
Work Phone*
Email*
example@example.com
If you have further questions, comments, or concerns about this application or payments, please contact Cathy Anderson, Compliance Manager at canderson@girlsincatl.org.

If you have further questions pertaining to programs, please contact Lea Christianna Nelson, Senior Program Manager at lnelson@girlsincatl.org or Shikera Cook, Youth Program Manager at scook@girlsincatl.org.
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Girls Inc. Enrichment at Ivy Prep Academy

Girls Inc. Girl Media Release

Parent/Guardian Contact Information

Emergency Contact Information

Emergency Contact Information