Alaska Military and Youth Academy
Date of Birth:
Address:(Street&House/Apt# or PO Box#):
How did you find out about ChallenNGe?
Applicant's Statement - Please state why you desire to be accepted to the ChalleNGe program:
Would you like a staff member to call you?
Do you meet one or more of the following descriptions?
Behind in Credits
Have you ever been convicted, indicted, or charged with a felony?
Was the charge as an adult?
Parent/Guardian Home Phone#:
Parent/Guardian Work Phone#:
Parent/Guardian Name 2:
Parent/Guardian Home Phone# 2:
Parent/Guardian Work Phone# 2: