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    Application

    Home · Programs · Chicago · Urban Academy-Chicago · Forms · Application
    This application begins the process of enrollment for LYDIA Urban Academy. Please fill it out completely and accurately.
    Please fill out all information as it relates to the student applying for enrollment.
    Student Name
    Student Birthday
    Student Cell Phone
    Home Phone Number
    Student Email
    Home Address
    City
    State
    Zip Code
    Student Gender
    Student Race
    Place of Birth
    Student's First Language
    Student's Second Language
    Student's Faith or Religious Affiliation
    Please fill out all information as it relates to the student's primary guardian. This is the guardian who would first receive any correspondence for attendance, disciplinary problems, tuition, special functions, or other school related concerns.
    Guardian Name
    Relationship to Student
    Primary Phone Number
    Alternate Phone Number
    Email
    Home Address
    City
    State
    Zip Code
    Place of Birth
    First Language
    Second Language
    Highest Level of Education
    Occupation
    Faith or Religious Affiliation
    If there is a second guardian who may be contacted for school-related concerns, please fill out his or her information here. If there is no second guardian then you may skip this section.
    Guardian Name
    Relationship to Student
    Primary Phone Number
    Alternate Phone Number
    Email
    Home Address
    City
    State
    Zip Code
    Place of Birth
    First Language
    Second Language
    Highest Level of Education
    Occupation
    Faith or Religious Affiliation
    The emergency contact should be an adult individual who is NOT listed as a guardian. In the even of an emergency (medical or otherwise) guardians will be contacted first. If no guardian can be reached, the emergency contact will be called.
    Emergency Contact Name
    Relationship to Student
    Primary Phone Number
    Alternate Phone Number
    If the primary guardian speaks English then you may skip this section. If the primary guardian does not speak English then please have a reliable adult contact who can relay information between the school and the student's home.
    English Speaking Contact Name
    Relationship to Student
    Primary Phone Number
    Alternate Phone Number

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