If you would like us to mail you an application, please fill out your information below.  

1.  Complete the information below and send.
2.  Click on download application.
3.  Complete and send.

Fields with an asterisk (*) are required.





Would you like a staff member to mail you an application?
Yes No 

Applicant Information

Date of Birth (required)*

First Name (required)*

Middle Name

Last Name (required)*

Your Email (required)*

Home Phone Number

Cell Phone Number

Address (required)*

Apartment/Suite

City(required)*

State (required)*

ZipCode (required)*

County

Race/Ethinicity

Male Female 

How did you hear about ChalleNGe?

Please state why you desire to be accepted to the ChalleNGe Program

Would you like a staff member to call you?
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Best Time to call?

Do you meet one or more of the following?
 habitually truant drop out expelled behind in credits home schooled none apply

Have you ever been convicted, indicted or charged with a felony?
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Parent/Guardian Information

First Name

Last Name

Relationship

Home Phone Number

Work phone Number

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Please allow 4-7 business days to receive the application packet.
>**NOTE** This is only a pre-application. The actual application should appear after you press the Send button. You may also click on Cadet Application under the RESOURCES Tab. This application can be emailed or printed.