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Treatment Program Application
Program Details

The first step TO A

Second Chance

New Student Application

Text Messages

Teens Gender

My Teen is Suicidal

My Teen Has Hurt Themselves

My Teen Has Expressed Suicidal Thoughts

My Teen Has Attempted Suicide

To What Degree has/does Your Teen Use Marijuana?

To What Degree has/does Your Teen Use Alcohol?

My Teen Is Prone To Violence

My Teen Is Prone To Violence Towards

My Teen Has Been In Trouble With The Law

My Teen Has Been Arrested

My Teen Is On Probation

My Teen Has Been In Counseling

My Teen Has Been Diagnosed With:

Does Your Teen Have a History of Truancy?

Has Your Teen Ever Been Expelled from Any School?

Does Your Teen have an Individualized Education Program (IEP)?

Has Your Teen Ever Attempted To Run Away from Home?

Was Your Teen Successful In Running Away From Home?

How Has Your Teen Returned Home in the Past?

Is Your Teen Sexually Active?

Sexual Deviancies:

Physical Activity


Does Your Teen have a History of Arson?

Eating Disorders:

Is Your Teen's IQ above 85?

My Financing Options Include:

Having Problems Submitting the Form?

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