Good News Academy Application - Good News Ministries

Program Dates:
Fall Semester August 17, 2026 - December 23, 2026
Spring Semester January 4, 2027 - May 7, 2027
Summer Semester May 17, 2027 - August 6, 2027

Thank you for your interest in Good News Boys Home! We accept a limited number of male applicants ages 14-18 for our free 12-month Academy program. Please complete the 9-page application below.

CHILD'S BASIC INFORMATION

Upload Photo*

Max. file size: 1 GB.

Childs Name*

First Last

Date of Birth*

Current Age*

Please enter a number from 5 to 99.

Address*

Street Address Address Line 2 City State ZIP Code

Child's SSN*

Emergency Contact Name*

Emergency Contact Number*

How did you hear about the Program?

ADDITIONAL INFORMATION

What do you see as the present problem concerning your child?*

What would you like to see accomplished in your child's life through his participation in our Academy program?*

Does your child consider himself to be*

Does your child want to attend our program?*

Yes

No

Unsure

LEGAL GUARDIAN INFORMATION

Legal Guardian #1*

First Last

Legal Guardian #2

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Address

Street Address Address Line 2 City State ZIP Code

Phone*

Phone

Email*

Email

Relationship to child*

Relationship to child

MEDICAL INSURANCE INFORMATION

Hoosier Healthwise or Medicaid Number. If you have a different medical insurance provider, enter "N/A"*

If not Hoosier Healthwise, Name of Insurance company. If you have Hoosier Healthwise or Medicaid, enter "N/A"

Insurance Company Phone Number

Group #

Policy #

File

Accepted file types: jpg, png, Max. file size: 1 GB.

Current Conditions and Medications

Describe all current medical problems including treatments and medications.

Name of Condition or Disorder #1

Names of medications and dosages for condition or disorder #1

Name of Condition or Disorder #2

Names of medications and dosages for condition or disorder #2

Name of Condition or Disorder #3

Names of medications and dosages for condition or disorder #3

Name of Condition or Disorder #4

Names of medications and dosages for condition or disorder #4

Please list all allergies

Name

This field is for validation purposes and should be left unchanged.

Good News Boys Home Application

Program Dates:
Fall Semester August 17, 2026 - December 23, 2026
Spring Semester January 4, 2027 - May 7, 2027
Summer Semester May 17, 2027 - August 6, 2027

CHILD'S BASIC INFORMATION

EDUCATIONAL HISTORY

ADDITIONAL INFORMATION

LEGAL GUARDIAN INFORMATION

MEDICAL INSURANCE INFORMATION

IMMUNIZATION RECORD

Current Conditions and Medications

Links

Good News Boys Home Application

Program Dates: Fall Semester August 17, 2026 - December 23, 2026 Spring Semester January 4, 2027 - May 7, 2027 Summer Semester May 17, 2027 - August 6, 2027

CHILD'S BASIC INFORMATION

EDUCATIONAL HISTORY

ADDITIONAL INFORMATION

LEGAL GUARDIAN INFORMATION

MEDICAL INSURANCE INFORMATION

IMMUNIZATION RECORD

Current Conditions and Medications

Links

Program Dates:
Fall Semester August 17, 2026 - December 23, 2026
Spring Semester January 4, 2027 - May 7, 2027
Summer Semester May 17, 2027 - August 6, 2027