Alaska Department of Military and Veterans Affairs Alaska Military Youth Academy

First Name: *

MI:

Last Name: *

Date of Birth: * (Reminder: Applicant must be 16-18 years old on the start date of the cycle to qualify)

Email: * (Email is primary form of contact, you must provide a valid email address)

Cell Phone: *

If phone preferred, best time to call:

Have HS diploma/GED?: *

Select your gender: *

Mailing Address: *

City: *

State: *

Zip Code: *

Parent/Guardian Name 1:

Relation:

Hm Phone#:

Wk Phone#:

Parent/Guardian Name 2:

Relation:

Hm Phone#:

Wk Phone#:

Who is requesting this information? *

If "Other", please specify:

How did you find out about ChalleNGe? Another applicant told Me From an AMYA Graduate From a family member From friends at school From school staff or school counselor From a social worker, probation officer, etc. From a paper advertisement (Brochure, Mail Out) From TV or the radio Other – Please describe in next box

If other, please describe:

Please note this is NOT the application but information to start the admissions process. You will receive an email within 2 business days to confirm the applicants qualifications as well as additional information on how to complete the application process. A full list of qualifications can be found in AMYA Qualifications.