"Request for Information - Keystone State Challenge Academy" - Pennsylvania

Request for Information - Keystone State Challenge Academy is a legal document that was released by the Pennsylvania Department of Military and Veterans Affairs - a government authority operating within Pennsylvania.

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Request for Information
Thank you for your interest in the Keystone State ChalleNGe Academy.
Please complete the form below and an Admissions Advisor will reach out to you to discuss more about the program.
Section 1: Youth’s Information
Last Name
First Name
Age
Gender
Address Line 1
Address Line 2
City
State
Zip
County
Section 2: Parent/ Legal Guardian Information
Last Name
First Name
Relationship to Youth
□ Parent/Step-Parent
□ Legal Guardian
□ Other ____________________________
Address Line 1 (If different than youth’s)
Address Line 2
City
State
Zip
Phone Number
Email
Preferred Contact Method
Best Time to Contact
□ Phone
□ Email
□ Text Message
□ Mail
Section 3: Additional Questions (To Be Completed by Youth)
How did you find out about the
Keystone State ChalleNGe Academy?
Why do you wish to be accepted into
the Keystone State ChalleNGe
Academy?
Are you at-risk of not completing high
□ Yes
□ Yes
Have you ever been convicted of/ facing criminal charges?
school or have dropped out?
□ No
□ No
Please return this form by:
Email: RA-MVPACHALLENGE@pa.gov
Mail:
BLDG 0-13A
Fort Indiantown Gap
Annville, PA 17003
Request for Information
Thank you for your interest in the Keystone State ChalleNGe Academy.
Please complete the form below and an Admissions Advisor will reach out to you to discuss more about the program.
Section 1: Youth’s Information
Last Name
First Name
Age
Gender
Address Line 1
Address Line 2
City
State
Zip
County
Section 2: Parent/ Legal Guardian Information
Last Name
First Name
Relationship to Youth
□ Parent/Step-Parent
□ Legal Guardian
□ Other ____________________________
Address Line 1 (If different than youth’s)
Address Line 2
City
State
Zip
Phone Number
Email
Preferred Contact Method
Best Time to Contact
□ Phone
□ Email
□ Text Message
□ Mail
Section 3: Additional Questions (To Be Completed by Youth)
How did you find out about the
Keystone State ChalleNGe Academy?
Why do you wish to be accepted into
the Keystone State ChalleNGe
Academy?
Are you at-risk of not completing high
□ Yes
□ Yes
Have you ever been convicted of/ facing criminal charges?
school or have dropped out?
□ No
□ No
Please return this form by:
Email: RA-MVPACHALLENGE@pa.gov
Mail:
BLDG 0-13A
Fort Indiantown Gap
Annville, PA 17003