AKMYA | Applicant Information Request

First Name:

MI:

Last Name:

Date of Birth: (Applicant must be 16-18 years old on start date of cycle to qualify)

Phone Number: Cell Home Work

Email: (Email is primary form of contact, you must provide a valid email address)

Other ways to contact me:

Call

Text

Mail

If calling is preferred, best time to call:

Have HS Diploma/GED? Yes No

Gender: Female Male

Ethnicity

Mailing Address:

City:

State:

Zipcode:

Parent/Guardian 1 Information:

Name:

Relation:

Parent/Guardian 1 Email:

Phone Number: Cell Home Work

Parent/Guardian 2 Information:

Name:

Relation:

Parent/Guardian 2 Email:

Phone Number: Cell Home Work

Who is requesting this information?

Applicant Parent/Guardian Other

If "Other", please specify:

How did you find out about Challenge?

If "Other", please describe:

Please note this is NOT the application but information to start the admissions process. You will receive an email within 2 business days to confirm the applicants qualifications as well as additional information on how to complete the application process. A full list of qualifications can be found in AMYA Qualifications.

Applicant Information Request

Next Cycle Begins:

July 16, 2024

Click to Start

Applicant Information Request Form

Parent/Guardian 1 Information:

Parent/Guardian 2 Information: