Youth Challenge Academy | Online Application

Online Application – Kalaeloa

Virtual Orientations by Appointments Only

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Applicant Name*

First Last

Applicant Gender*

Male

Female

Applicant Birth Date*

Applicant Age on 01/18/2023*

Parent/ Guardian Name

First Last

Relationship

Phone*

Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current High School*

What cycle are you looking to enroll in?*

SPRING (January 2023 - June 2023) [Class 58]

Please select your Orientation date*

How did you hear about the program?*

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