This page contains all the necessary steps required for admittance into Teen Challenge of Western PA. Please read carefully. Start at the Disqualifiers section and work your way through the steps.






Disqualifiers | Overview | Step 1 | Step 2 | Step 3 | Checklist



Disqualifiers

You cannot enter Teen Challenge if:

1. You are currently taking any psychotropic medication for Depression/ Anxiety/ Psychosis
  a. You may wean yourself off of the medication under medical supervision and then apply for admission
  b. A letter from your primary care physician verifying your weaning from the medication must be
 included in the physical exam forms.

2. You have been convicted of any sexual offences

3. You are not willing to commit to a year-long program and..

4. You are not open to being taught Biblical Christianity as the way to be free from drug and alcohol addiction



Overview

Before entry date can be promised ,you must mail or fax the following items

1. A complete physical examination form with all lab results   The Instructions for these items are found in STEP 1

!!*You must use the Physical exam form
included in our application packet!!


2. All fees must be sent to Teen Challenge (money order only).  STEP 2

3. Three Forms of I.D. (xerox copy enlarged 200%) and the fully completed application packet must be mailed or faxed.  STEP 3

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Step 1

Application download and Physical Exam Form

1. Before anything else, you need to download and print an application packet.
- Click the following link to retrieve the application as an Adobe Acrobat file. DOWNLOAD APPLICATION.

- Then open the file using the program called "Adobe Acrobat".
- If you do not have this program, Click here to download a free version.

2. Print the application packet and locate the section titled "Medical History and Physical Examination Form"

3. This section must be filled out by a physician.

!!!IMPORTANT!!!   !!!IMPORTANT!!!
Be sure that the doctor fills out Every line
on the physical exam form Doctors tend to
leave sections EIGHT and NINE blank


4. Four sets of lab work must also be attached to the completed physical exam form
  • RPR
  • Liver Function Tests
  • Hepititis Screening (If liver function is abnormal)
  • TB Test

5. Make sure the Doctor's name and address are legible and the form is complete

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Step 2

Intake Fee, Employer Letter and Sponsorship Form

1. There are two amounts of money due at the time of entry
a. $750.00 intake fee
b. $100.00 return fare

*MONEY ORDERS ONLY PLEASE. MADE PAYABLE TO "TEEN CHALLENGE".

2. There are also two different letters needed :
a. A letter from your last employer stating your earnings and your dates of employment.
b. A letter from whoever has supported you during the past year.

3. Locate the sponsership form in the application packet
- Please ask friends, family, or church members to support your stay at Teen Challenge with a monthly contribution.
- Remember, our program is funded primarily by individual and church donors

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Step 3

Three Forms of I.D. and completed Application Packet

1.The following I.D. is required to enter Teen Challenge

a. Social Security Card
b. State or Federally issued photo I.D.
c. Birth Certificate

*Items (a.) and (b.) MUST be enlarged by 200% for legibility*

2. Fill out all additional pages in the application packet. These include:

a. Referral Questionnaire
b. "Do You Understand" form signed and dated
c. The Three Consent to Release Confidential Information Forms
d. The Three "Prospective Student Acknowledgment" Forms

3. When these are all completed, please use the checklist below to ensure you have all necessary materials

!!IMPORTANT!! Ensuring all checklist items
are completed will increase the speed at which
we can admit you or your loved one into the
program for help

4. You can then Fax everything to (724) 265-4105 or mail it to

P.O. Box 55
Rural Ridge, PA 15075

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Checklist

Utilizing this Checklist will ensure faster admission date

Click Here for a printer friendly version of this checklist

Before faxing or mailing the packet, does it contain all the following:

All 14 Pages of the downloaded application packet; completed, signed and dated in all required places

A completed physical exam form with the four required lab results

The letter from your past employer

The letter from whomever supported you over the last year

Copy of Social Security Card enlarged 200%

Copy of Photo I.D. enlarged 200%

Copy of Birth Certificate

Trust that God will be present in the midst of your pain