• Preliminary Application

    Preliminary Application

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  • Basic Information

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  • NEW YORK ADULT & TEEN CHALLENGE EXISTS FOR INDIVIDUALS TO EXPERIENCE FREEDOM FROM ADDICTION BY HELPING THEM TO KNOW CHRIST, GROW IN CHRIST, SERVE CHRIST, AND SHARE WHAT CHRIST HAS DONE FOR THEM.

  • SUBSTANCE ABUSE HISTORY

  • LEGAL INFORMATION

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  • MEDICAL HISTORY

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  • APPROVED PSYCHOTROPIC MEDICATION LIST

  • New York Adult & Teen Challenge (NYATC) permits the following approved psychotropic medications for anxiety and depression diagnoses:

    Approved SSRIs/Approved SSNRIs/Non-Addictive Anti-Depressants:

    • Citalopram (Celexa)
    • Escitalopram (Lexapro)
    • Fluoxetine (Prozac)
    • Fluvoxamine (Luvox)
    • Paroxetine (Paxil)
    • Sertraline (Zoloft)
    • Desvenlafaxine (Pristiq)
    • Duloxetine (Cymbalta)
    • Venlafaxine (Effexor)
    • Milnacipran (Savella)
    • Levomilnacipran (Fetzima)
    • Milnacipran (Remeron)

    Approved NDRI

    • Bupropion (Wellbutrin)

    Approved Anticovulsant

    • Lamotrigine (Lamictal) *approved ONLY for seizures @ Director's discretion.
    • Gabapentin (Neurontin) *approved ONLY for nerve pain @ Director's discretion.

    Psychotropic medication prescribed for any of the following diagnoses, regardless of if it is listed above, is NOT APPROVED:

    • Bi-polar
    • Psychosis
    • Schizophrenia
    • Paranoia
    • OCD
    • Sleep

    *Key: Generic Name Version (Brand Name Version)

  • Admission:

    Documents for Admission:
    ▪ Driver’s License or Other Picture ID - Required
    ▪ Social Security Card – Required
    ▪ Birth Certificate (Original or Certified Copy) – If Available
    ▪ DD 214 Form (Applicants with Prior Military Service) – If Available

    Other Items You May Bring:
    You should bring the following items if you have them. If you do not have them and do not have the means to purchase them, do not worry. We have the ability to provide many of these items at no cost to you.

    CLOTHING: 
    Gloves
    Coat (during winter) – Raincoat - Umbrella
    Black or dark blue suit jacket (male) 
    Black or dark blue dress pants (male) 
    White dress shirts (long or short sleeve) (male)
    Black or dark blue socks (male)
    Underwear
    Belt (male)
    Neckties (male)
    Black skirt (female)
    White Blouses (female)
    Nylons (female)
    Slips (female)
    Dress shoes (male & female)
    Jeans or casual slacks
    Collared shirts or blouses
    T-shirts (no obscene or inappropriate logos)
    Shorts (must cover ¾ of thigh)
    Dresses or skirts
    Sweatshirt
    Sweat pants
    White socks

    Shoes:
    Shower shoes
    Slippers
    Tennis shoes
    Casual shoes
    Boots (during winter)
    Dress Shoes

    TOILETRIES:
    Soap - Shampoo
    Comb - Brush
    Toothbrush - Toothpaste
    Towel - Washcloth
    Deodorant
    Disposable or electric razor – shaving cream
    Makeup
    Blow Dryer
    Foot Powder or spray
    Sanitary items

    LINENS:
    Blanket, Pillow, Pillow Case
    Twin Sheets

    MISC:
    Bible
    Envelopes - Stamps
    Small Clock Radio
    Family Picture (8”x10” maximum)
    Camera - Film
    Jewelry (leave expensive jewelry at home)

    MEDICAL:
    Immunization Records (if in High School)
    Health Insurance Data
    Prescription Medications (30 day supply)
    Non-prescription Medications (if desired)

  • Important Notes:

    You may not bring any of the following items with you when being admitted. If you do, you will be required to immediately dispose of them or mail them home at your own expense. 

    • More than two suitcases of items
    • Expensive Jewelry
    • Expensive Clothing or other valuable items
    • Items of Sentimental Value (except family photo - 8”x10” maximum)
    • DVD Players – DVDs
    • Video Games
    • Radios – (except as part of an alarm clock)
    • Televisions
    • Computers
    • Cell Phones
    • Musical Instruments
    • Books (other than a Bible and one devotional book)
    • Magazines, newspapers, or other printed articles
    • Weapons of any kind
    • Tools of any kind
    • Recreation Equipment
    • Playing Cards
    • Games
    • Dice
    • Illegal Drugs
    • Drug Paraphernalia
    • Alcohol
    • Tobacco Products
    • Personal Vehicle


    We recognize the importance of music, games, recreation, entertainment, and other activities in the proper growth
    and development of our residents. We will provide the necessary equipment and opportunity for these activities.

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