Keystone State ChalleNGe Academy Application

Required fields are marked with an asterisk (*).

Personal information

Address

Your parent/legal guardian information

Your parent/legal guardian address

KSCA uses the alternate contact when they cannot easily reach the applicant and parent/guardian throughout the application process.
 
This contact could be anyone in the applicant’s life, like a school administrator or community member. They must be at least 18 years old. 

Alternate contact information

Alternate contact address

Your parent/legal guardian will sign this section to give permission to KSCA to gather and receive your school records.

School information

Guidance counselor information

Our goal is to understand your health history, so we know how to provide the right care and are aware of any pre-existing medical conditions.

All health information will be confidential and private. Disability accommodations and other needs are available. 


You will need to fill additional health care information and have a physical exam by a health practitioner later within the application process.

Conditions and illnesses

Select all past and current conditions.

Medications, surgeries, and injuries

Mobility, vision, and hearing

Additional information

Please answer the questions honestly and accurately. Your application is not automatically disqualified based on your answers without careful consideration. Each application is reviewed individually, to ensure a fair and thorough review process.   

Your answers are kept confidential and private.

Mental health

Please answer the questions honestly and accurately. Your application is not automatically disqualified based on your answers without careful consideration. Each application is reviewed individually, to ensure a fair and thorough review process.   

Your answers are kept confidential and private.

Upload any relevant court documents

Upload files

There is a limit of 5 attachments, with each file having a maximum size of 20MB. The supported file types are .jpg, .png, .doc/docx, and .pdf.

Please review all information before submitting the application. We recommend that you save or print these responses for your records.

Applicant

I agree and certify that I have read and understand all sections and consent to the digital submission and processing of this application.

I agree that all statements and information provided are truthful and are completed to the best of my knowledge and ability.

I authorized the Commonwealth of Pennsylvania's cities, counties, school district, and state agencies to provide all pertinent information with the Keystone State ChalleNGe Academy (KSCA).

Information could be, but not limited to substance abuse history, court history, family or social services interventions, documented medical conditions. All health, safety, welfare, and quality of life information is used for KSCA admission purposes.

Signature

Parent/legal guardian

I agree and certify that I have read and understand all sections and consent to digital submission of the application for further processing of this application.

I agree that all statements and information provided are truthful and are completed to best of my knowledge and ability.

I authorized the Commonwealth of Pennsylvania's cities, counties, school district, and state agencies to provide all pertinent information with the Keystone State Challenge Academy (KSCA).

Information could be, but not limited to substance abuse history, court history, family or social services interventions, documented medical conditions. All health, safety, welfare, and quality of life information is used for KSCA admission purposes.