Online Application Form : Mens Center (Okanagan)

Instructions:

  • Give FULL and COMPLETE answers to ALL questions after you have read "Overview of the BC Teen Challenge Program". Misleading or incomplete information may jeopardize your application.


  • The entrance fee to this program is $500.00 (nonrefundable), which must be paid in full on your admission day. We DO NOT accept Personal Cheques. Payments can be made by certified cheque, money order, cash, VISA or Mastercard.


  • We don't not accept applicants to this program who DO NOT have a life-controlling problem.
    • First Name: Middle Name:
    Last Name:
    EMail Address:
    Current Address:
    City/Town: Province/State
    Postal Code/Zip: Age:
    Phone Number:
    Date of birth:
    Person to contact in case of emergency: Relationship to you:
    EMail Address:
    Their Home Phone: Their Work Phone:
    Their Address:
    City/Town
    Health Card # Province of Health Card
    Place of Birth
    Are you a Canadian Citizen or Landed Immigrant? Do you fluently read, write and speak English?
    Please State last grade completed: Height:
    Weight:
    Why are you applying for help to Teen Challenge?
    Why are you applying to us instead of another program?
    Who referred you to us? Please include there phone number.
    Phone Number
    Describe your lifestyle concerning drugs and alcohol during the past six months.
    Do you have, or have you ever had a psychiatric condition?
    Are you currently taking prescribed medications? Why?
    Do you have a history of violence? Please give details.
    Are you currently in jail? If yes, why are you in jail, and when will you be released?
    If in jail, what is the name and address of the institution?
    Do you have any court cases pending? If yes, what for?
    Are there any outstanding warrants for your arrest? If yes, for what?
    Are you currently on a disability or other pension?
    Please mention any other information we should know about you.

    Agreements
    1) I understand that the BC Teen Challenge program is twelve months long. The Induction Phase of the program is six months long with completion based upon progress in counseling and academic completion of assignments. Once I complete the Induction Phase then the Training Phase of the program begins, which is an additional six months of applying what was taught in Phase One. The Training Phase is based on the ability to handle a more strenuous curriculum and to demonstrate a willingness to grow stronger spiritually, emotionally, and behaviorally with God's help.
    2) I understand that BC Teen Challenge is primarily a Christian discipleship training center where the primary goal is a student's wholeness through the power of God.
    3) I understand that BC Teen Challenge is a interdenominational Christian treatment program
    4) I agree to participate in daily Christian classes approximately 4 hours per day.
    5) I agree to participate in daily manual labor as part of the work detail program approximately 4 hours per day.
    6) I agree to participate in one-on-one counseling and will cooperate fully as a student in the program.
    7) I agree to fully participate in the organized recreation program as part of my basic training.
    8) I understand that BC Teen Challenge's expects students to quit all tobacco, drugs and alcohol cold turkey, NO EXCEPTIONS.
    9) I understand that BC Teen Challenge's policy is no smoking, no fighting, no girlfriends, and that hair styles and clothing must be modest to our exceptions, and that phone calls, visits, passes, music, and television are extremely limited, and that all mail is screened. Further that students communication via phones, mail, visits or passes must be approved in advance.
    10) I understand that there is a high emphasis on rules, structure, and discipline and I agree to fully cooperate with the program.

    PLEASE NOTE: Prior to acceptance by BC Teen Challenge, you will be required to attend an interview of approximately 30 minutes. During thisinterview we will require you to be candid about your life, as well as your addiction problems. If you live farther than 2 hours away, the interview may be held via telephone. We may also ask to interview friends and family to help gain a better understanding of you and your application.