Part I - Applicant Information

1a. FIRST NAME

1b. MIDDLE NAME

1c. LAST NAME

1f. GENDER

Male

Female

1g (cont). IF OTHER RACE, LIST

1h. ARE YOU A U.S. CITIZEN OR LEGAL PERMANENT RESIDENT

Yes

2a. STREET (Include Apt./Floor)

Part II - Parent / Guardian Information

3. PARENT/GUARDIAN NAME

3a. FIRST NAME

3b. MIDDLE NAME

3c. LAST NAME

4. APPLICANT LIVES WITH A

Parent

Guardian

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

Yes

Does Not Apply

Part III - School Information

6. LAST SCHOOL ATTENDED

7. ARE YOU CURRENTLY ENROLLED

Yes

8. LAST GRADE LEVEL COMPLETED

8th Grade

9th Grade

10th Grade

11th Grade

9. DID YOU OR DO YOU CURRENTLY HAVE AN INDIVIDUAL EDUCATIONAL PLAN (IEP)

Yes

10. DID YOU OR DO YOU CURRENTLY HAVE A 504 PLAN

Yes

Part IV - Additional Questions For The Applicant

11. HAVE YOU EVER BEEN ARRESTED

Yes

11a. PROVIDE DATES AND EXPLAIN ALL OFFENSES (All legal issues must be cleared prior to the class start date)

12. HAVE YOU EVER BEEN PLACED ON PROBATION / DEFERRED DISPOSITION

Yes

12a. PROVIDE DATES AND EXPLAIN ALL OFFENSES (All legal issues must be cleared prior to the class start date)

13. DO YOU HAVE ANY PENDING COURT DATES

Yes

13a. IF YES, WHEN AND WHERE

14. HAVE YOU ATTENDED ANY RESIDENTIAL OR TREATMENT PROGRAM

Yes

14a. IF YES, WHAT PROGRAMS

15. ARE YOU WILLING TO BE DRUG TESTED

Yes

16. HAVE YOU EVER BEEN A CANDIDATE OR CADET IN ANY YOUTH CHALLENGE PROGRAM

Yes

16a. IF YES, WHEN AND WHERE

17. ARE YOU VACCINATED FOR COVID-19

Yes

No, but willing

No and not willing

17a. IF YES, HOW MANY COVID SHOTS HAVE YOU RECEIVED

18. HOW DID YOU HEAR ABOUT THE NJ YOUTH CHALLENGE ACADEMY

19. TELL US WHY YOU WOULD LIKE TO BE ACCEPTED INTO THE NJ 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 12 & 13 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 four 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 VI - Signatures

Parent / Guardian signature is required regardless of the age of applicant.

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 address for the parent/guardian.

Pre-Application

Part I - Applicant Information

1. APPLICANT NAME

2. HOME ADDRESS

Part II - Parent / Guardian Information

3. PARENT/GUARDIAN NAME

Part III - School Information

6. LAST SCHOOL ATTENDED

Part IV - Additional Questions For The Applicant

Part V - Statement of Understanding

Part VI - Signatures

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