Alpha Academy Student Application

Alpha Academy Student Application

Please complete our application to apply for one of our residential programs.
Please select which program you are interested in:*

Alpha Residential ProgramOmega Residential Program
Full Name*

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address*
Phone Number

Area CodePhone 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?*

FacebookFriend or family memberInternet searchOther
Please verify that you are human*
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