Preliminary Application to Start a Center
Please fill out this form to begin the process of starting a new Adult & Teen Challenge center.
Applicant's Details
Applicant's Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a graduate of Adult & Teen Challenge?
Yes
No
Which Program?
Graduation Date
-
Month
-
Day
Year
Date
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Proposed Location
City/State
Type of Program
Please Select
Men (18+)
Women (18+)
Adolescent Boys (under 18)
Adolescent Girls (under 18)
Crisis & Referral
Re-entry
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Applicant's Christian Background
Church Denomination
Church Name
Pastor's Name
Pastor's Email
example@example.com
Pastor's Phone
Please enter a valid phone number.
Date of Salvation
-
Month
-
Day
Year
Date
Date of Water Baptism
-
Month
-
Day
Year
Date
Click here to read our Statement of Faith
Do you fully agree with ATC’s Statement of Faith?
Yes
No
Explain
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Why would you like to start an Adult & Teen Challenge center? Why now?
Submit
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