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Youth Application

Dear Applicant and Family,

Thank you for your interest in the Washington Youth ChalleNGe Academy. We look forward to receiving your application.

Our next classes is July 15, 2024. Each class is 5 1/2 months. We recommend completing your application now, so that you can be prepared and considered for admission.

This application consists of 12 short pages. Use the Next and Previous buttons at the bottom of the form to navigate between pages.

Use the Save and Resume Later link to save your work. The Save and Resume Later feature will let you finish the application later if you don't have time now.

The Washington Youth ChalleNGe Academy, in accordance with Title VI, the Civil Rights Act Washington State Law and WA MIL Department policy, does not discriminate based on age, sex, sexual orientation, gender expression or gender identity, marital status, race, creed, color, national origin, or disability.

Applicant Information

Which class are you applying for?*
Applicant Name as it Appears on the Birth Certificate. If no middle name, type "NONE."*
Applicant preferred name:*
Preferred name*
Use preferred name instead of legal name for:

If you live in an apartment, put the apartment number in the Address Line 1.

Physical Address*
Is your mailing address the same as your physical address?*
Mailing Address*
Format: XXX-XXX-XXXX (leave blank if no phone)
Gender*
Current Age*
If you are 15, you must be at least 15 ½ and will need Director approval for admission.
Ethnicity*
Race*

Eligibility Criteria

Will you be 16-18 years of age on the first day of the program you are applying for?*
Will you turn 16 between July 15, 2024 and December 13, 2024?*
Are you a citizen or legal resident of the United States?*
Are you a resident of Washington State?*
Are you behind in credit, academically deficient, or a high school dropout?*
Academically deficient youth has a high potential of dropping out of school due to academic standing. Youth who are not on track to graduate with their cohort, no longer attending school regularly and who has not received a diploma or GED are eligible to apply.
Have you ever been convicted of a felony, or under indictment of a felony?*
Are you unemployed or underemployed?
An individual who is not regularly employed in full-time work.
Are you employed?*
Can you be free from the use of illegal drugs or substances while in the Program?*
Drug testing will take place throughout the program.
Are you physically and mentally capable of participating in the WYCA?*
Reasonable accommodations will be made for identified disabilities. Accommodation will be arranged prior to entry into the program

Family

-- Select income range --
Does your family receive any Public Assistance
Public assistance for your family could include: TANF, EBT (food), or Medical
-- Select number of people (including yourself) --
Are you married?*
Do you have any children?*
Are one or both of your parents (or legal guardians) currently in prison?*
In prison, jail, county detention, deportation facility, etc.
Are you a foster child?*
Are you adopted?*
Are you homeless?*
Homeless

Additional Information

Do you know anyone else applying to the same class?*
Have you ever been a participant in the Washington Youth ChalleNGe Academy or other ChalleNGe program?*
How did you or your family find out about the WYCA?*
Do you smoke, vape or use tobacco products?*
Have you ever abused alcohol or been drunk?*
Have you ever used illegal drugs or abused prescription drugs?*
Have you ever been treated or hospitalized for drug use?*
Are you a member of a gang, affiliated with a gang, or hang around with a gang?*
Are you currently on an At-Risk Youth Petition?*
An At-Risk Youth petition is a request from a child's parent or legal guardian to the Juvenile Court to assist the parent in maintaining the health and safety of their youth.
Are you currently on a Truancy/BECCA Petition?*
Truancy petitions are filed by the school district with the Juvenile Court when students have excessive absences.

Education

Are you currently enrolled in school?*
What is your current grade level?*
Are you currently home schooled?*
Do you have a learning disability?
Are you currently receiving Special Education services (Individualized Education Plan) or Section 504 accommodations?*
Have you ever received Special Education services (Individualized Education Plan) or Section 504 accommodations in the past?*
Have you ever been suspended or expelled from high school?*

High School Suspension/Expulsion

For each incident of your high school suspension or expulsion, list the Grade Levels and Reasons.

Grade Level (1st incident)*
Grade Level (2nd incident)
Grade Level (3rd incident)
Grade Level (4th incident)

Legal History

Have you ever been arrested, or convicted of a crime?*
Are you currently involved in any legal proceedings/awaiting sentencing?*
Are you currently on a diversion?*
Are you currently on probation?*

For each incident, state the date, crime, and result. 

Date

Crime

Result

Other Result: 

Other Result: 

Other Result: 

Other Result: 

Medical History

The medical history questions below are a starting point for Admissions.  A sports physical and a dental exam on WYCA documents must be completed and submitted to Admissions. Applicants are required to complete all necessary dental work as part of the acceptance process. 

Applicant Name*
Have you been hospitalized overnight in the past 5 years?*
Have you had surgery in the past 1 year?*
Are you missing any paired organs such as kidneys, lungs, testicles. etc?*
Have you ever passed out during exercise?*
Have you ever had a head injury in the past 5 years that resulted in a concussion or unconsciousness?*
For example: 2021-football game-mild concussion; 2020-skateboarding-severe concussion, hospitalized; 2019-car accident-unconscious no treatment.
Have you ever had heat exhaustion, heat stroke or heat cramps?*
Have you ever experienced numbness or tingling in your arms, hands or feet?*
Are you currently diagnosed with asthma?*
Are you currently prescribed a rescue inhaler?*
Do you have allergies to any medications?*
For example: Penicillin-hive-mild; Aspirin-stomach upset-severe.
Do you have allergic reactions to insect bites, bee stings, pollen, latex, etc.?*
For example: Dust-sneezing-mild with meds; Bee sting-anaphylactic shock-life threatening-epi pen.
Are you allergic to any foods?*
For example: Strawberries-hive-mild; Milk except cheese-stomach cramps-moderate; Gluten-Celiac disease-severe diet restrictions.
Do you take any regular or intermittent prescription medications?*
For example: Albuterol-Asthma0inhaler as needed; Doxcycline-Acne-2 times per day.
Do you have all the immunizations required to attend a Washington State public school?*
WYCA Health Center staff will verify immunizations for all applicants through the Washington Department of Health database.
Have you ever been diagnosed/treated for ADD or ADHD?*
For example: I was diagnosed in 6th grade. I function fine when I take the medication; I was diagnosed in 2nd grade and I don't have this any more. I was diagnosed last year and I don't take the medication because I don't like the way it makes me feel.
Do you have a history of violent outbursts or difficulty managing your anger?*
For example: I get really mad when things don't go my way. I punch holes in the wall and yell.
Have you attempted suicide within the last 12 months?*
Are you currently being treated by your doctor or a behavioral health professional for mental health reasons?*
What is your doctor or behavioral health professional treating you for?*
Check all that apply.
Are you currently prescribed medication for behavioral health reasons, regardless of whether you are taking it or not?*

Limited Medical Services  

The WYCA is NOT a hospital, medical, dental or mental health clinic. We have a licensed nurse on staff. For this reason, we are unable to accept applications from Applicants who require ongoing medical, behavioral health counseling services or dental care for conditions that originated prior to arrival at the program or that develop after enrollment that prevents their full participation on a daily basis. Minor illnesses and injuries that arise during the program are handled on a “sick call” basis. Cadets with more serious illnesses or injuries will be taken to a local clinic or hospital emergency room as appropriate. Please note, if the illness or injury is serious, it could jeopardize the Cadet’s continued enrollment. The WYCA does not have staff available to transport Cadets to frequent medical, dental or vision appointments or provide ongoing treatment. Cadets with medical issues that will impact their daily participation will be dismissed and sent home. The Cadets can reapply to a future class and compete for admission as long as they are in good standing in all other areas. Any periodic appointments for preventative medical, dental or vision care must be made when the Cadet is at home during a scheduled “home pass”.  Appointments scheduled while on home pass should not overlap with the Cadet’s scheduled time for return, as this will put the Cadet at risk of not completing the required training and attendance for successful completion. These policies and procedures are intended and designed to ensure the safety, health and welfare of the Cadets and staff of the WYCA.

Acknowledgment of Limited Medical Services*

Applicant Custody Information

On this page the the terms "mother" and "father" are used. These refer to the parents listed on the applicant's birth certificate. The legal guardians may or may not be the same as the parents.

Legal Guardian

Who is the legal guardian (and has custody of) the applicant?

Legal Guardian #1*
Legal Guardian #2

Mother of Applicant 

Name of mother on applicant's birth certificate.

Mother*
Is this person (mother of applicant) still alive?*
Is there a father on the applicant's birth certificate?*

Father of Applicant 

Name of father on applicant's birth certificate.

Father*
Is this person (father of applicant) still alive?*


Are the mother and father of the applicant divorced or separated?*
Who has custody of the applicant?*
Is there a parenting plan in place regarding educational/medical decisions for the applicant?*

Emergency Contact and Pick Up Information

Below you will find space for up to three people for routine and emergency contact information for the applicant:

  • Two spaces for parents or legal guardians.
  • One space for an alternative contact person. 

You must provide at least 2 of the 3 contacts. Both must be authorized to pick-up the applicant.

Unless designated otherwise, contact is in the order listed. Only people listed on this page will be given information, and be allowed to pick-up for home passes and appointments.

#1 -- Primary Parent/Legal Guardian

Name*
Relationship to the applicant?*
Is this person authorized to pick-up applicant from the Academy?*
Format: XXX-XXX-XXXX
Same as Applicant address*
Address*

#2 -- Primary Parent/Legal Guardian

Name
Relationship to the applicant?
Is this person authorized to pick-up applicant from the Academy?
Format: XXX-XXX-XXXX (leave blank if no phone)
Same as Applicant address?
Same address as #1 contact above?
Address*

#3 -- Alternative Emergency Contact

Name*
Relationship to the applicant?*
Is this person authorized to pick-up applicant from the Academy?*
Format: XXX-XXX-XXXX

Goals and Personal Statement

What do you hope to accomplish by attending the Washington Youth ChalleNGe Academy (WYCA)?*

APPLICANT PERSONAL STATEMENT. The WYCA is a voluntary program. The youth applicant should complete this section without parent or guardian assistance. Using AI to write this statement is prohibited.

Please write a statement that answers ALL the questions below.

1. What would you like us to know about you?
2. How did you hear about the WYCA and why did you apply?
3. Why are you credit deficient and academically at-risk?
4. What are your goals and how will attending the WYCA help you with these goals?

The Personal Statement is one of the components used to select youth for the program. Answering ALL the questions above in 100 or more words will offer the greatest opportunity for admission to the program.

Final Page

Please review your application before submission.

All required questions must be completed in order to submit the application.

Have you reviewed your application and are you ready to submit it?*

After you submit your application, you will have a deadline to complete and submit the additional documents listed on our website.

I understand that I have a deadline to complete the remaining documents.*

By signing below, you ensure to the best of your knowledge, all information provided is true and accurate. I acknowledge that WYCA has limited medical services and additional medical documents will need to be submitted for Admission. 

The WYCA is a volunteer program. YOUTH APPLICANTS MUST CONSENT TO ATTEND AND SIGN BELOW WITHOUT PARENT/GUARDIAN ASSISTANCE. Parent/Guardian signature for youth will result in application rejection.

Use your mouse or finger to draw your signature above
A parent or legal guardian must also sign for Applicants under 18.
Use your mouse or finger to draw your signature above
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