• Online Application Form
• Admissions FAQ
• Why Choose Us?
• Requirements & Eligibility Guidelines

Online Application Form

Get Help Today!

Applying to Teen Challenge is quick and easy. Just fill out the information required below and submit your application along with the processing fee. Acceptance of an applicant will not be determined until all components have been received by Teen Challenge.

If you are accepted, you will be placed on a waiting list pending available space. When a bed becomes available, your entrance day will be scheduled. To maintain your position on the waiting list, you are required to call the centre weekly to demonstrate your continued interest in the program.

STEP 1

Provide us your contact information.

STEP 2

Tell us about yourself and your current circumstances.

STEP 3

Submit your application. Allow 72hrs for response ...easy as 1,2,3!

Centre Applying To

Please select one Alberta Men's Centre Atlantic Men's Centre Ontario Women's Centre Ontario Men's Centre Ontario North Men's Centre Saskatchewan Men's Centre

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Contact Information

First Name *

Middle Name

Last Name *

Address *

City *

Country * Province * PC * Select Canada United States Select

Date of Birth * MM 01 02 03 04 05 06 07 08 09 10 11 12 DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 YYYY 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Email Address *

Phone Number *

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Emergency Contact Information

Emergency Contact Name *

Relationship to You *

Contact Address *

Contact City *

Country * Province * PC * Select Canada United States Select

Contact Phone Number *

Contact Work Number *

Email Address *

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