Pre-Application Thank you for your interest in applying to the New Jersey Youth ChalleNGe Academy. Please use the online pre-application below. Alternately, you can download the pre-application and submit it via mail, email or fax using the instructions provided. Online Pre-Application Part I - Applicant Information1. NAME1a. FIRST 1b. MIDDLE 1c. LAST 2. DATE OF BIRTH 3. AGE 4. GENDER Male Female5. RACE (Used for statistical purposes only) Asian or Pacific Islander Hispanic Black, not of Hispanic Origin White, not of Hispanic Origin Indian or Alaskan Native Other 5a. IF OTHER RACE, LIST 6. EMAIL 7. HOME PHONE 8. MOBILE PHONE 9. ADDRESS9a. STREET (Include Apt./Floor) 9b. CITY 9c. STATE 9d. ZIPCODE 9e. COUNTY Part II - School Information10. LAST SCHOOL ATTENDED 10a. SCHOOL NAME 10b. STREET 10c. CITY 10d. STATE 10e. ZIPCODE 11. ARE YOU CURRENTLY ENROLLED Yes No12. LAST GRADE LEVEL COMPLETED 8th Grade 9th Grade 10th Grade 11th Grade13. DID YOU OR DO YOU CURRENTLY HAVE AN INDIVIDUAL EDUCATIONAL PLAN (IEP) ON FILE THERE Yes No Part III - Parent / Guardian Information14. APPLICANT LIVES WITH A Parent Guardian14a. IF DIVORCED, DOES THE PARENT THE APPLICANT LIVES WITH HAVE SOLE CUSTODY Yes No Does Not Apply15. NAME15a. FIRST 15b. MIDDLE 15c. LAST 16. EMAIL 17. HOME PHONE 18. MOBILE PHONE 19. WORK PHONE 20. ADDRESS20a. STREET 20b. CITY 20c. STATE 20d. ZIPCODE Part IV - Applicant Questionnaire21. PLACE OF BIRTH21a. CITY 21b. STATE 21c. COUNTRY United States (US)AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe22. ARE YOU A U.S. CITIZEN Yes No22a. IF NOT A U.S. CITIZEN, DO YOU HAVE LEGAL RESIDENT STATUS (Must provide written proof) Yes No23. HAVE YOU EVER BEEN ARRESTED Yes No23a. PROVIDE DATES AND EXPLAIN ALL OFFENSES (All legal issues must be cleared prior to the class start date) 24. HAVE YOU EVER BEEN PLACED ON PROBATION / DEFERRED DISPOSITION Yes No24a. PROVIDE DATES AND EXPLAIN ALL OFFENSES (All legal issues must be cleared prior to the class start date) 25. DO YOU HAVE ANY PENDING COURT DATES Yes No25a. IF YES, WHEN AND WHERE 26. HAVE YOU ATTENDED ANY RESIDENTIAL OR TREATMENT PROGRAM Yes No26a. IF YES, WHAT PROGRAMS 27. I UNDERSTAND THAT INITIAL AND ONGOING DRUG TESTING WILL OCCUR THROUGHOUT MY ENROLLMENT AND THAT A POSITIVE DRUG TEST WILL RESULT IN IMMEDIATE DISCHARGE (Applicant initial here) 28. HAVE YOU EVER BEEN A CANDIDATE OR CADET IN ANY YOUTH CHALLENGE PROGRAM Yes No28a. IF YES, WHEN AND WHERE 29. ARE YOU VACCINATED FOR COVID-19 Yes No29a. IF YES, HOW MANY SHOTS HAVE YOU RECEIVED 29a. IF NOT VACCINATED ARE YOU WILLING TO BE VACCINATED Yes No30. HOW DID YOU HEAR ABOUT THE NEW JERSEY YOUTH CHALLENGE ACADEMY 31. TELL US WHY YOU WOULD LIKE TO BE ACCEPTED INTO THE NEW JERSEY YOUTH CHALLENGE ACADEMY Part V - Statement of Understanding I fully understand that the New Jersey Youth ChalleNGe Academy is a residential Academy that includes GED instruction, military training and employment preparation. At this time, I am in good health and capable of meeting the rigorous physical training schedule I will experience at the New Jersey Youth ChalleNGe Academy. I am drug free and I do not have an active alcohol and/or drug abuse problem. I am not under the jurisdiction or supervision of a juvenile or circuit court nor are there any actions pending against me in a general district court except as noted in questions 24 & 25 above. The applicant/legal guardian understands that by submitting this pre-application, the applicant has NOT BEEN ACCEPTED. The applicant SHOULD NOT withdraw from, nor cease to attend, High School even if they have received a conditional acceptance letter until just before the ChalleNGe class start date. To the best of my knowledge, all statements made in this application are accurate and truthful. I further understand that the information I have given in the first three parts of this application is subject to verification and that I may be disqualified from the Academy if it is determined that the information I have provided is untrue. By submitting this pre-application, I agree that any information I provide may be stored and made available to any person having a legitimate need for the information. I further understand that New Jersey Youth ChalleNGe Academy personnel shall determine who has such a need for this information. By submitting this online form, I acknowledge the Privacy Notice for the New Jersey Department of Military and Veterans Affairs. Part V - SignaturesParent / Guardian signature is required regardless of the age of applicant.APPLICANT DATE PARENT / GUARDIAN DATE I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the Statement of Understanding above. We will send a confirmation receipt to the email addresses provided for the applicant and for the parent/guardian. SUBMIT Signup For Our Newsletter SUBSCRIBE Want to know more about us? Contact Our Team