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 Information

1. NAME

1a. FIRST

1b. MIDDLE

1c. LAST

2. DATE OF BIRTH

3. AGE

4. GENDER

Male

Female

5. 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. ADDRESS

9a. STREET (Include Apt./Floor)

9b. CITY

9c. STATE

9d. ZIPCODE

9e. COUNTY

Part II - School Information

10. LAST SCHOOL ATTENDED

10a. SCHOOL NAME

10b. STREET

10c. CITY

10d. STATE

10e. ZIPCODE

11. ARE YOU CURRENTLY ENROLLED

Yes

12. LAST GRADE LEVEL COMPLETED

8th Grade

9th Grade

10th Grade

11th Grade

13. DID YOU OR DO YOU CURRENTLY HAVE AN INDIVIDUAL EDUCATIONAL PLAN (IEP) ON FILE THERE

Yes

Part III - Parent / Guardian Information

14. APPLICANT LIVES WITH A

Parent

Guardian

14a. IF DIVORCED, DOES THE PARENT THE APPLICANT LIVES WITH HAVE SOLE CUSTODY

Yes

Does Not Apply

15. NAME

15a. FIRST

15b. MIDDLE

15c. LAST

16. EMAIL

17. HOME PHONE

18. MOBILE PHONE

19. WORK PHONE

20. ADDRESS

20a. STREET

20b. CITY

20c. STATE

20d. ZIPCODE

Part IV - Applicant Questionnaire

21. PLACE OF BIRTH

21a. CITY

21b. STATE

21c. COUNTRY

22. ARE YOU A U.S. CITIZEN

Yes

22a. IF NOT A U.S. CITIZEN, DO YOU HAVE LEGAL RESIDENT STATUS (Must provide written proof)

Yes

23. HAVE YOU EVER BEEN ARRESTED

Yes

23a. 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

24a. 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

25a. IF YES, WHEN AND WHERE

26. HAVE YOU ATTENDED ANY RESIDENTIAL OR TREATMENT PROGRAM

Yes

26a. 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

28a. IF YES, WHEN AND WHERE

29. ARE YOU VACCINATED FOR COVID-19

Yes

29a. IF YES, HOW MANY SHOTS HAVE YOU RECEIVED

29a. IF NOT VACCINATED ARE YOU WILLING TO BE VACCINATED

Yes

30. 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 - Signatures

Parent / 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.

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Pre-Application

Part I - Applicant Information

1. NAME

9. ADDRESS

Part II - School Information

10. LAST SCHOOL ATTENDED

Part III - Parent / Guardian Information

15. NAME

20. ADDRESS

Part IV - Applicant Questionnaire

21. PLACE OF BIRTH

Part V - Statement of Understanding

Part V - Signatures

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