Student Questionnaire | International ALERT Academy

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Application Forms

Student
Questionnaire

FORM 1:
Initial Form

FORM 2:
Student Questionnaire

FORM 3:
Parent Questionnaire

FORM 4:
Medical Questionnaire

FORM 5:
Physical Questionnaire

"*" indicates required fields

Name*

First/Alias Last

Email*

Photographs*

Upload 1 family photograph and 2 personal photographs, taken within the last year.

Where did you hear about ALERT?*

Friend

Brother

Online

Social Media

Other

Social Media*

Facebook

Instagram

YouTube

TikTok

Other

Who?*

Who was most influential in your decision to come to ALERT?*

Personal History

Which of the following programs have you attended/been involved in?

Select all that apply.

ALERT Cadet

Journey to the Heart

Quest

Which year did you attend Quest?*

Physical

Have you ever been involved in a sexual relationship?

Yes

Have you ever fathered children?

Yes

Have you ever been physically beaten or sexually molested?

Yes

Please explain:

Have you ever been involved in criminal activity?

Yes

Have you ever been convicted of criminal activity?

Yes

Please explain:

Do you have any tattoos on your body, or are you considering obtaining one before coming to ALERT?

Yes

Where is it located?*

Which of the following have applied, or do apply, to your life?

Pornography

Smoking

Using street drugs

Drinking alcohol

Mental

Do you often find yourself having difficulty controling what you think of?

Yes

Do you struggle with any of the following?

Select all that apply

Depression

Anxiety

Thought Life

Have you ever been evaluated for a learning disability?

Yes

Please explain:

How many hours of TV/Movies do you watch per day?

per week?

per month?

How many hours do you spend playing video/computer games per day?

per week?

per month?

How many hours per week do you spend reading?

What books have you read in the past two months?

How many hours a day do you spend on your phone?

Spiritual

If you were to die tonight, do you know where you would spend eternity?

Yes

Please write your salvation testimony and what being a Christian means to you.

Are you plagued with doubts concerning your salvation?

Yes

Using the following scale, rate your spiritual walk with the Lord.

1 being spiritually cold and distant from the things of God and 7 being very dynamic, active spiritual life and walk with God

Are you presently making a point to fellowship with other believers?

Yes

Where and when?

Are you under the authority of a local church where the Bible is taught?

Yes

Church

Denomination

Pastor's Name

Do you have a regular devotional time in the Bible?

Yes

When and to what extent?

Do you find prayer mentally difficult?

Yes

Explain

What is the greatest struggle in your spiritual life and your walk with the Lord?

Emotional

Is there someone in your life with whom you could be emotionally honest right now (i.e., you could tell this person exactly how you feel about yourself, life, and other people)?

Yes

Who?

If you could change anything about yourself, would you?

Yes

What would it be, and why?

Life Perspective

Describe a time where someone in authority placed restrictions on an area of your life, and how you reacted:

Describe a time when you were placed in a situation where the right decision wasn't clear, and how you handled it:

Describe a time when you were asked to do something that you didn't want to do even though you knew it was the right thing to do. How did you respond?

In your opinion, what is your greatest weakness or need?

Have you ever rebelled? Describe, and to what degree:

Have you ever run away from home?

Yes

When?

For how long?

Explain:

Are you employed?

Yes

What is your job?

Hours per week?

Have you ever been terminated from a position?

Yes

Explain:

Family Relationships

Is there harmony and a sense of security in your home?*

Yes

Has there been abuse, neglect, etc.?*

Yes

Explain

What is your parent's maritial history?

Married

Widowed

Divorced

Other

Explain your father and mothers' relationship:*

Are you adopted or a foster child?

Yes

How old were you when you joined your current family?

Explain your relationship with your parents:*

Who is the spiritual leader of your home? Has that always been? Explain:*

Personal Vision

How does ALERT fit into God's plan for your life?

Is ALERT training your choice?

Yes

Explain (If necessary)

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The International ALERT Academy does not discriminate in its admissions or educational policies and programs on the basis of race, color, or national and ethnic origin.