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.
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
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
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 ____ 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?
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 Achiever'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?
What is your dream job or career after high school?
Do you have a started/completed personal statement?
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:
How did you hear about this program?
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
Parent/Guardian Signature
Should be Empty:

2026-2027 Registration

Applicant Information

Demographic Information

PROGRAM INFORMATION

PARENT/GUARDIAN INFORMATION