Completing the Residential Program Application

At the bottom of this application, you may choose to either submit the application online, or you may print it and mail it to:

The Community School
PO Box 555
Camden, Maine 04843

IMPORTANT NOTE: PLEASE FOLLOW UP WITH A PHONE CALL TO VALERIE AT 236-3000 TO CONFIRM THAT YOUR APPLICATION WAS RECEIVED.

Residential Program Application

About You

Your Name:
Email Address:
Phone:
Best Time to call:
Social Security Number:
Birthdate:

Your Current Address

Street:
City:
State:
Zip:

Your Permanent Address

Street:
City:
State:
Zip:

Your Parents

Your Parents' Names:
Parent's Phone:
Relationship to Parents: Birth Parents Adoptive Parents
Step Parents Foster Parents

School

Name of School:
SAD#:
Teacher who knows you best:
Guidance Counselor:
Principal:
Superintendant:
Have you ever attended an alternative program? Yes No
Who referred you to the C-School:
Date you last attended school:
Age:
Grade:

Other Important Folks

Counselor's Name:
Phone:
Social Worker's Name:
Phone:
Probation Officer's Name:
Phone:
Lawyer's Name:
Phone:
Doctor's Name:
Phone:
Other Important Person's Name:
Phone:

Some Questions We Would Like to Ask

In your own words, why do you think you dropped out or failed to achieve in school?

How has your family helped (or not helped) your efforts to stay in school?

Have you ever been in a substance abuse treatment program? Evaluate your experience there:

List any medications you take:

Why do you want to attend the Community School?

Evaluate Yourself on a Scale of 1-10 (10 as the Best Rating)

            1     2    3    4    5    6    7    8    9    10
Work: (Worst) (Best)
Academics: (Worst) (Best)
Motivation to come to the C-School: (Worst) (Best)
Motivation to leave home: (Worst) (Best)
Living with others: (Worst) (Best)
Understanding yourself: (Worst) (Best)
Completing the things you start: (Worst) (Best)
Avoiding dependent relationships with a boyfriend/girlfriend: (Worst) (Best)
Taking care of your health: (Worst) (Best)
Avoiding substance abuse: (Worst) (Best)
or
Copyright © 2007 The Community School. Site generously designed and hosted by Doug Felton Web Development and Design Services.