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Student Application

Application


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  • MM slash DD slash YYYY
















  • Parent / Guardian / Sponsor Info


  • First Name Last Name Relationship Address Home Phone Mobile Phone Email Preferred Method of Contact
  • First Name Last Name Relationship Address Home Phone Mobile Phone Email Preferred Method of Contact
  • First Name Last Name Relationship Address Home Phone Mobile Phone Email Preferred Method of Contact
  • First Name Last Name Relationship Address Home Phone Mobile Phone Email Preferred 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. Please include adult children who live separately and parents that the child does not live with.

  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed Contact
  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed Contact
  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed Contact
  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed Contact
  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed Contact
  • Name Relationship to Student Age Household Status Substance User Mental Health Issues Allowed 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.
  • Name Relationship Mailing Address
  • Name Relationship Mailing Address
  • Name Relationship Mailing Address
  • Name Relationship Mailing 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 of Dates of City State Reason for Disposition of arrest(s)
  • Number of Dates of City State Reason for Disposition of arrest(s)
  • Number of Dates of City State Reason for Disposition of arrest(s)
  • Number of Dates of City State Reason for Disposition of arrest(s)
  • Charge Court Date
  • Charge Court Date
  • Charge Court Date
  • Charge Court Date




  • P.O. Name Address Phone Email
  • P.O. Name Address Phone Email
  • 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.



























  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details
  • Issue Details


  • Date Method Required Hospitalization (Yes/No) Lethality Notes
  • Date Method Required Hospitalization (Yes/No) Lethality Notes
  • Date Method Required Hospitalization (Yes/No) Lethality Notes
  • Date Method Required Hospitalization (Yes/No) Lethality Notes


  • Date Method Required Hopsitalization (Yes/No) Lethality Notes
  • Date Method Required Hopsitalization (Yes/No) Lethality Notes
  • Date Method Required Hopsitalization (Yes/No) Lethality Notes
  • Date Method Required Hopsitalization (Yes/No) Lethality Notes
  • Substance Abuse History

  • Medical History

  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
  • Medication Dosage Frequency Reason for Med Length of Time on Med
































  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Issue Explain with Details
  • Name Address Phone Number Date of Last Visit
  • Name Address Phone Number Date of Last Visit
  • Name Address Phone Number Date of Last Visit
  • Treated for Date(s) Length of Stay Place of Service/City/State
  • Treated for Date(s) Length of Stay Place of Service/City/State
  • Treated for Date(s) Length of Stay Place of Service/City/State
  • Treated for Date(s) Length of Stay Place 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



  • Date Discharge Data Agency/Program Phone Reason for Treatment Results of Treatment
  • Date Discharge Data Agency/Program Phone Reason for Treatment Results of Treatment
  • Date Discharge Data Agency/Program Phone Reason for Treatment Results of Treatment
  • Date Discharge Data Agency/Program Phone Reason for Treatment Results of Treatment
  • Date Discharge Data Agency/Program Phone Reason for Treatment Results of Treatment


  • Entry Date Discharge Date Agency/Program Phone Reason for Treatment Results of Treatment
  • Entry Date Discharge Date Agency/Program Phone Reason for Treatment Results of Treatment
  • Entry Date Discharge Date Agency/Program Phone Reason for Treatment Results of Treatment
  • Entry Date Discharge Date Agency/Program Phone Reason for Treatment Results of Treatment
  • Entry Date Discharge Date Agency/Program Phone Reason for Treatment Results of Treatment
  • Academic Information

  • School Name Dates Attended Phone/Fax Contact Email
  • School Name Dates Attended Phone/Fax Contact Email
  • School Name Dates Attended Phone/Fax Contact Email
  • School Name Dates Attended Phone/Fax Contact Email
  • School Name Dates Attended Phone/Fax Contact Email
  • Insurance Information


Should you need help finding homes for troubled boys, homes for troubled youth, or troubled teenagers programs, 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. The Christian boarding school for troubled boys offers a comprehensive, faith-based program designed to help boys overcome personal and behavioral challenges.  The curriculum combines rigorous academic instruction with Christian teachings, fostering both intellectual growth and moral development. Students engage in daily chapel services, Bible study, and prayer, which help them build a strong spiritual foundation and develop a personal relationship with God. Therapeutic support is a key component of the school, addressing the underlying issues contributing to the students’ difficulties. Counselors and therapists work with the boys individually and in group settings to provide emotional support, coping strategies, and behavior modification techniques. By providing a well-rounded experience, this Christian boarding school aims to equip troubled boys with the tools they need to succeed in life and become productive, compassionate members of society. Through a combination of faith, education, and therapy, our Christian boarding school strives to transform the lives of troubled boys and set them on a positive, fulfilling trajectory.

Student Application

If your son is struggling with life-controlling issues, fill out an application for Teen Challenge Adventure Ranch in Arkansas.

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