Intake Day Parent Letter 070819


Please do NOT print forms unless instructed to print the forms by the administration office.

Verification of Withdrawl Form.PDF

Tuberculosis Evaluation (PPD).PDF

Physical Form

Dental Exam Form.PDF

Packing List.PDF

Digital Forms Section

Only Complete Forms You Need

The following digital forms are available below for your convenience.

  • Digital Release of Confidential Information
  • Student Pre-Application

  • South Carolina Youth ChalleNGe Academy

    Digital Release of Confidential Information

    It is requested that any professional, legal, educational, medical or mental health information you have regarding the individual above be released to the South Carolina Youth Challenge Academy, 5471 Leesburg Road, Bldg 3892, Eastover, SC 29044.

    This information includes any medical reports, psychological reports, psychiatric evaluations, psychiatric hospital records, mental health reports or summaries, school transcripts/records (to include Individual Education Plans, psychological reports , 504 plan, BIP, birth certificate, social security card, immunization records, attendance records, discipline records, etc.), legal and/or criminal history records and status, DJJ Form V, evaluations and other pertinent information which schools, counselors, medical professionals, mental health professionals/agencies, legal professionals or agencies, may have needed for review to decide on acceptance at the South Carolina Youth Challenge Academy.

    I Understand my refusal to consent to the release of information specified above will prevent disclosure of such information to South Carolina Youth Challenge Academy, thereby removing my application from consideration or causing my dismissal from the program.

    Student Signature(required)

  • Date Format: MM slash DD slash YYYY
  • Please enter a number from 4 to 4.
  • Parent/Guardian Signature (required)

  • Date Format: MM slash DD slash YYYY

SC Youth Challenge Academy
Student Pre-Application