Commonwealth ChalleNGe Application (Part One)

> <img Decoding=, Commonwealth ChalleNGe Youth Academy

Download and print this application

To apply for admission complete the  Application as thoroughly as possible and attach the required forms. PLEASE DO NOT LEAVE ANY FORM BLANK. Please download and print the application, once complete mail or email (admissions@vachallenge.org), your completed application.

After we receive the complete Part One, please continue to work on Part Two.

Provide the following documents in this order:

  • Application Forms: Complete pages 1 and 2 entirely and accurately.
  • Legal Information Form.
  • Court Documents that: Provide charge(s), type(s) of charge(s), pending court dates, results of charge(s).
  • Consent for Release of School Information Form.
  • School Transcript(s): Obtain a copy from the school.
  • Medical History Survey: Parents and the child will fill this form out and sign it.
  • Mental Health Survey: Parents and the child will fill this form out and sign it.
  • Mentor Application: Bring your mentor or potential mentor with you to Orientation. Questions about Mentors can be answered by calling (757) 491-5932 Ext 240 .

Important Supporting Documents needed for Part One

  • Birth Certificate: Provide a copy of your birth certificate or legal permanent resident card
  • Individual Education Plan/504 (IEP)
  • Social Security Card: Provide a copy of your social security card.
  • Child Custody Documents/Adoption Papers: Please provide us the most current copy of any child custody documents/adoption papers.

Once you submit all the above paperwork, continue to work on Part 2.

PART TWO OF THE APPLICATION WILL REQUIRE:

  • Medical Insurance Verification: Provide a copy of your insurance card front & back.
  • A valid Virginia ID card: provide for GED testing (Note: Needed after 2nd pass).
  • Provide a copy of your most current immunization record.
  • TB skin test or chest x-ray: must be done within 12 months prior to the start of class.
  • Physical Exam (Form is included in Part Two of the application. Use OUR form ONLY. No School/Doctor Office Physical Forms.)
  • Medical Authorization/Prescription Form (Included with Part Two)

Download and print this application