Alpha Student Application

Alpha Student Application

Please complete our form to apply for a residential or non-residential position with us.
Full Name *

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address *
Phone Number

Area Code Phone Number
Please list 3 references with their contact information.
How far have you gone in school? Explain your experience growing up.
Have you ever had trouble with the police or courts? Please explain.
Do you have any medical conditions or allergies?
What is your history and current situation with drugs and alcohol?
What is your motivation to come to Alpha Academy?
How would you define success for a person?
What dreams do you have for your life?
What knowledge or skills would you like to take with you when leaving the program?
Describe your spiritual life currently and growing up.
What is your commitment to the program? What value will you bring to the group?
When would you like to start?
Where did you find out about our program? *

Facebook Friend or family member Internet search
Please verify that you are human *
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