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Student Application

Application

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Parent / Guardian / Sponsor Info

  • First NameLast NameRelationshipAddressHome PhoneMobile PhoneEmailPreferred Method of Contact
  • Parent / Guardian / Sponsor

  • NameRelationshipAddressHome PhoneMobile PhoneEmailPreferred Method of Contact
  • Referral Information

  • General Information

  • Parent / Guardian Report

  • Teen Challenge hosts six mandatory family events each year. This is for parents only and if there are two parents in the home, both are required to attend.
  • Family Information

    Do not include extended family (I.e. grandparents or aunts and uncles) unless that family member has had guardianship or care of the child in the past. Pleast include adult children who live separately and parents that the child does not live with.
  • NameRelationship to StudentAgeHousehold StatusSubstance UserMental Health IssuesAllowed Contact 
  • Students may receive correspondence from immediate family, pastors, teachers, and/or counselors. Please let us know who you would like your child to receive mail from.
  • NameRelationshipMailing Address 
  • Describe the relationship between your child and...

  • A copy of the divorce decree and custody arrangements will need to be submitted to Teen Challenge with these forms
  • Legal History

  • Number ofDates ofCity and StateReason forDisposition of arrest(s) 
  • ChargeCourt Date 
  • P.O. NameAddressPhoneEmail 
  • Issues Assessment: What is leading you to seek treatment for your child at this time? Describe your child's current difficulties and note when these behaviors / issues recently escalated. Please be very specific and include dates if when possible. For example: drug/alcohol abuse, anxiety, anger, depression, self-mutilation, pornography, self-image, suicidal/homicidal thoughts, etc.
  • IssueDetails 
  • DateMethodRequired Hospitalization (Yes/No)LethalityNotes 
  • DateMethodRequired Hopsitalization (Yes/No)LethalityNotes 
  • Substance Abuse History

  • Medical History

  • MedicationDosageFrequencyReason for MedLength of Time on Med 
  • MedicationDosageFrequencyReason for MedLength of Time on Med 
  • IssueExplain with Details 
  • NameAddressPhone NumberDate of Last Visit 
  • Treated forDate(s)Length of StayPlace of Service/City/State 
  • Developmental History

  • Testing and Diagnosis

  • Treatment / Placement History

    Please include all previous counseling, inpatient, psychiatric, psychological, or any other professional services received
  • DateDischarge DataAgency/Program PhoneReason for TreatmentResults of Treatment 
  • Entry DateDischarge DateAgency/Program PhoneReason for TreatmentResults of Treatment 
  • Academic Information

  • School NameDates AttendedPhone/FaxContactEmail 
  • Insurance Information

Teen Challenge Endorsers

  • Ronald Reagan

    Former President

    Ronald Reagan

    “Teen Challenge gives our kids something to live for – a relationship with God, a healthy self-esteem, and a direction in their lives that finally leads somewhere.”

  • John Ashcroft

    Former Attorney General

    John Ashcroft

    “Teen Challenge changes the world one person at a time.”

  • Charles Colson

    Founder, Prison Fellowship

    Charles Colson

    “The Teen Challenge program succeeds when all of the government programs have failed.”

  • George Bush

    Former President

    George W. Bush

    “Too many young [people] have already lost their lives. Teen Challenge works to change young people’s lives by changing their hearts.”

  • Art Linkletter

    Television Personality

    Art Linkletter

    “In my opinion, Teen Challenge is doing the best all-around job of providing the kids with something meaningful in their lives. And that’s what they all need.”

  • John Howard

    Former US Drug Czar

    Dr. John A. Howard

    “Of all the programs reported to the Commission, the most successful is the program conducted by Teen Challenge.”

  • Jim Blanchard

    Past Director, AT&T Corporation

    Jim Blanchard

    “Teen Challenge is one of the most successful programs in our country.”

PO Box 20 • Morrow, AR 72749
Telephone: (888) 289-6818
Fax: (888) 844-1669

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Should you need help finding ranches for teens, teen boarding schools, Christian schools for troubled teens or reform schools, please let us know. Teen Challenge Adventure Ranch is a Christian therapeutic boarding school and boys home. Boys come to our therapeutic school and home in Northwest Arkansas from across the United States. We help at-risk boys who struggle with behavioral issues. Therapeutic boarding schools and boys homes like Teen Challenge offer behavioral therapy and a rehab for troubled teen boys with teen counseling for boys. It is an affordable therapeutic ranch for at-risk teenage boys, boys with anger, oppositional defiant disorder (ODD), attention deficit disorder (ADD), and attention deficit hyperactivity disorder (ADHD) or rebellion. If you are searching for alternative schools or residential treatment centers for boys, addiction treatment for teens, troubled youth homes, troubled teen schools or troubled teen boarding schools, you have found one. A top therapeutic school and addiction treatment center for teenage boys, we may also be referred to as a “school for troubled teens”. Troubled teen schools and residential treatment programs for addicted teens provide troubled pre-teen and teenage boys with counseling and addiction treatment.

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