Teen Achievers Registration

2026-2027 Registration

Achievers is a comprehensive youth and adult development program focused on leadership development, college and career readiness, personal growth, and community impact. Through a structured, multi-academy model, Achievers equips participants with the skills, confidence, and real-world experience needed to succeed in school, work, and life. Progress is tracked through assessments, milestones, and impact metrics. Our program moves participants from potential to purpose through intentional mentorship, experiential learning, and measurable outcomes. This is not a one-size-fits-all program; it's a developmental pathway built for long-term success. Each Achiever progresses through targeted academies designed to meet them where they are and prepare them for what's next. Please complete a registration for each student. Note that the program begins with a mandatory kick off retreat at Camp Chingachgook on from September 25 - 27. Applicants are considered fully enrolled after attending the retreat. The annual program fee of $250 is due by July 30th. Limited income-based scholarships are available.
Applicant Information
Student's Full Name

First NameLast NameSuffix
Participant's Cell Phone
(Please DO NOT use parent's #. If student does not have a phone, enter zeros)Format: (000) 000-0000.
Applicant's Email Address

Confirmation Email(If your child does not have a Gmail address, please create one now)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home City
Home Zip
Demographic Information
Applicant's Date of Birth

MonthDayYear
Student Ethnicity/Race
Select all that apply.
How does the applicant self-identify?
Applicant's Pronouns
Full Name of School Attending in the Fall
Note "Home Schooled" with the associated school district. Ex. Home schooled - City School District of Albany
Grade Entering in the Fall
School City
School Zip Code
I am a resident of

Other
Student Ethnicity/Race
Does your student have an IEP or 504 in place? If so, someone will contact you for details?
Please upload a copy of the plan

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This will be my student's ____ year in the program.
Household's highest level of education
Student's Shirt Size
Household size
Annual household income:
Is your student eligible for free or reduced lunch?
Are you requesting a program fee scholarship?
Scholarship Process
Scholarships are limited and income-based. We will do our best to accommodate applicants based on the available funds in our scholarship fund.

Everyone is required to make the $50 deposit during registration. This will be deducted from your balance after the scholarship is applied.

Please note that promos cannot be combined with scholarship awards.

Payment must be made in full by July 30th

Proof of Household Income

Please provide all items from Section A. If no one in your household completes a 1040 Tax Form, you have no pay stubs, and are not seeking help with childcare, please provide at least one item from Section B. Scholarships will only be considered for applications with ALL required documentation uploaded. Not doing so will delay the processing of your scholarship.

Section A - Provide All of These Documents
- Latest 1040 Tax Form
- 2 pay stubs
AND

Section B - Please Provide ONE of These Documents
- W2 Form
- Social Security Benefit Statement
- Current 1099 Form
- Unemployment documentation: DSS Award letter
Please upload your most current 1040 tax document AND your last 2 paystubs

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Please upload one of the documents listed under section B above.

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Special Financial Circumstances: Please tell us about special financial circumstances such as the loss of a job, the death of a spouse, a medical illness, or other circumstances impacting your financial situation.
PROGRAM INFORMATION
Any dietary restrictions? Please list. If none, write "None."
Any allergies? Please list. If none, write "None."
Any medical conditions or medications? Please list. If none, write "None."
Enter the name of your student’s Adult Achiever mentor.
Please Upload a Clear Solo Photo of the Participant

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Is your student working or involved in athletics or other extra curriculars?
Please list them with the, if available, schedule
ACHIEVER APPLICANT RESPONSE: Tell us about your interests or what you hope to ACHIEVE in this program
Which pathway are you interested in focusing on for Senior Academy? Please select only one pathway.
What is your dream job or career after high school?
Do you have a started/completed personal statement?
Please upload your personal statement here. It's OK if it's not perfect. We just want an idea of where you are.

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What is your school counselor's name?
What is your school counselor's email address?
What colleges/universities/vocation or trade schools interest your student?
PARENT/GUARDIAN INFORMATION
Parent/Guardian #1 Full Name
Parent/Guardian #1 relationship to student
Parent/Guardian #1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #2 Name
Parent/Guardian #2 relationship to student
Parent/Guardian #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #2 Email
example@example.com
Authorized Pick Up
Please identify someone other than a parent if possible.
Authorized Pick Up Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick Up Relation to Student:
What session are your registering for?
Regardless of the session selected. ALL Achievers are required to attend the Kickoff Retreat, Immersion Days, and where applicable: I.E.D.s, College Tours, Summits, and other major program experiences.
Band is our program-wide and PRIMARY communication platform. Please also share how you prefer us to communicate with you individually.
Select Your Site - NexGen Academy
Select Your Site - LevelUp Academy
Select Your Site - BluePrint Academy
Select Your Site - Junior Academy
Select Your Site - Senior Academy
How did you hear about this program?
I certify that the information provided here is accurate and complete to the best of my knowledge, and that I have provided all available documentation, as requested. I also confirm that I fully understand that my attendance at the parent orientation and my student's attendance at the Kick-Off retreat are mandatory for my student to participate in the program.
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