Adult & Teen Challenge Baltimore Men's Home Application

Adult & Teen Challenge Baltimore

Men's Center Application
Disqualifying Factors:

1) Individuals who have records of sex offenses which may present a risk to the community due to the City of Baltimore's regulations and restrictions.

2) Individuals with legal restraints which would preclude them from participating in the program and which cannot be sorted out by our Admissions office with the legal authority.

3) Individuals with medical problems which requires excessive time away from our residential program and/or unable to particpate in our work therapy program.

4) Individuals taking mind altering or mood changing drugs.

You Must Agree to the Following:

1.Are you willing to give up all legal and illegal drugs and alcohol

2. Are you willing to give up all narcotic and or psychotropic medications. (Anti-Depressants, Anxiety, ADHD, Bi-Polar, Schizophrenia) *With Doctors Approval*

3. Are you willing to give up all nicotine products?

4. Are you willing to give up all contact with friends, girlfriends, fiancés to only focus upon yourself and reconciliation with immediate family only?

5. Are you willing to not have access to your cell phone or any other electronics while being enrolled?

6. Are you willing to stay enrolled the minimum one year in order to graduate?

CLICK HERE TO PLEASE READ OUR STUDENT HANDBOOK
01. I agree that the disqualifying factors do not apply and I agree to all other requirements. *

I Agree

Personal Questions:

Please fill these out with great effort and honesty.
Why do you want to enter Adult & Teen Challenge Baltimore? *
As you see it, what is your problem? *
What have you done about your problem before now? *
How do you think Adult & Teen Challenge Baltimore will help you? *
Anything else you would like to share?
If accepted are you committed to completed the the one-year commitment? *

Yes No

AGREEMENTS
I agree to commit myself to the full one-year program.

I AGREE
I agree and understand that while I am enrolled I will not be allowed to carry money or have a cellphone, girlfriend, take psychotropic and/or narcotic medication or use nicotine products.

I AGREE
I agree and understand that if I am currently receiving SSI/Disability I will be required to give 70% towards my monthly tuition.

I AGREE
I agree to not use drugs or alcohol and fully commit myself to changing my life.

I AGREE

Signature and Submission
By signing this applicaton and submitting it you are agreeing that all the information filled in is true and correct to the best of my ability. I understand that if I we're to put incorrect or false information on this application it could result in denial of the application and or dismissal from the program at a further date.
Applicant Signature *
Date *

Month Day Year
Enter the message as it's shown *
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Adult & Teen Challenge Baltimore