Troubled Teen Help Request Form

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Parent First Name
Parent Last Name
Email
Phone
Zip
School Information
Please choose the school type that best describes your interest
Choose a description that describes your current situation
Would you consider a school or program outside of your immediate geographical location? Yes No
Specialty Schools can be very expensive, and you usually get what you pay for. Depending upon the services offered the average monthly tuition can range from as low as $2,500 and go as high as $8,000. If the school of your choice was the "perfect" solution for your child, what monthly tuition rate would you be able to pay? Often families can qualify for long term low interest student loans. The monthly payments of these student loans have an average range of between $100.00 to $400.00. Average stay and cost for 6 weeks at a Wilderness Program would be $17,000 (actual length will be determined by each school) Monthly payments would average $118.00 per month. Average stay and cost for 12 months at a Therapeutic Boarding School is $54,000 (based on $4,500 a month tuition) Monthly payments would average $375.00 per month.
Do you need an Educational Consultant? Yes No
Teen Information
Teen Name
Relationship to you
Teen Gender	Male Female
Age
Current Medications / Diagnosis
Please describe the problems you are having with your teen

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Troubled Teen Help Request Form

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School Information

Teen Information

Navigate The Information Maze!

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