DATC Seaford Men's Program Application Logo
  • Disqualifying Factors

    1) Individuals who have records of sex offenses which may present a risk to the community due to the City of Seaford'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.
    4) Individuals taking pschycotrophic medications (mind-alterling,mood-altering medications, sleep-aids, etc).

  • Delmarva Adult & Teen Challenge

    Men's Center Application
  • Personal Information

  • Family History


  • Physical Health History

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  • Disclaimer: Delmarva Adult & Teen Challenge reserves the right to prohibit entrance to individuals taking mind and/or mood- altering medications (e.g., Lithium, Prozac, Haldol, Ritalin, Valium, etc.)

    Please note: All medications used to treat depression, anxiety, pain and sleep disorders or other psychological problems are carefully screened at Delmarva Adult & Teen Challenge. Please consult your doctor before considering entry.

    Also Note: All students accepted into Delmarva Adult & Teen Challenge must have a tuberculosis test administered. RESULTS of that test must be submitted on the day of entry.

  • Legal Status

  • Miscellaneous History

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  • Employment History

  • Reason For Entry

  • Student Agreement Form

  • Signature and Submission

  • The undersigned student applicant fully acknowledges that the information provided herein is accurate and true to the best of his or her knowledge, and the application form has been completed and filled out by the student applicant. The student applicant further understands that any false or incomplete information may cause and result in disqualification from admittance or continuation in the program. The undersigned student gives permission for Delmarva Adult & Teen Challenge to contact any of the heretofore mentioned people and/or institutions. The undersigned student also understands that his residency at Delmarva Adult & Teen Challenge is at the will of Delmarva Adult & Teen Challenge and may be terminated at any time and for any reason.

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