Application for Admission

Name

FirstLast

Address

Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry

Phone

Email

Date of Birth

In Case of Emergency Contact:

Emergency Phone

Reference Name

FirstLast

Phone

Reference Name

FirstLast

Phone

Reference Name

FirstLast

Phone

Highest Level of Education Completed

Personal Information

(How you answer the following questions will not adversely affect your eligibility for the program. We just need to know where you are coming from.)

Have you ever been in any trouble with the police or the courts?

If yes, please include a detailed explanation.

Do you have any medical conditions or allergies? Are you taking any medication? What medical insurance (if any) do you have? When was your last physical? What are your ongoing medical needs (vision, dental, etc.)?

What is your history, and current situation, with drugs and alcohol? What have you used? When did you last use?

Entrance Essay

This portion of the application is designed to help us determine if you will be a good fit for Alpha Academy, and vice-versa. We are selective in our admissions process, because we want students who are serious about learning, and who are willing to work hard to be successful. It is important that students come to Alpha motivated to learn, with the understanding that their time here will be a time of stretching and growth.

What is your motivation to come to Alpha Academy?

How do you define success? Under what circumstances would you consider yourself successful? How does Alpha Academy fit into that definition?

What goals or dreams do you have for your life? What would you like to be doing in one year? Three years?

What do you expect to learn from Alpha Academy, and what knowledge or skills do you hope to acquire before leaving the program?

Describe your spiritual life at this point. In what ways would you like that area of your life to develop?

How do you plan to pay for Alpha Academy? What other sources of income (savings, SSI, etc.) do you have? What are your debts? (No one will be denied admission due to financial constraints. You will have an opportunity to work here.)

What is your time frame for coming to Alpha Academy? When would you like to start?

What is your commitment to Alpha Academy? What value will you bring to the program?

Initials*

I am applying for admission to Alpha Academy. I understand that my participation in this program is voluntary, and I may withdraw at any time. I further understand that my par- ticipation in the program is subject to review, and that I may be asked to leave at any time.

Initials*

I understand that drugs and alcohol are not permitted, and that Alpha Academy is a non- smoking facility.

Initials*

I am aware that Alpha Academy is a Christian organization, and that I will be expected to attend Bible studies and a Sunday church service as a part of my participation in the program.

Initials*

By my intials, I am agreeing to commit to the program for a six-month period, and to abide by the rules and requirements of Alpha Academy.

Date*

Application for Admission

Personal Information

Entrance Essay

Contact

Application

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