Welcome!

If you know of a student who would benefit from the ministry at Wears Valley Ranch, please tell us more by filling out this short interest form. This is a good first step to learn more about our program before beginning an application for admission.

Thank you for already investing in the life of this student. Our admissions staff is looking forward to connecting with you!

Name of Student*

Student's Age

Student's Gender*

Other Students

Student's current address

Name of individual completing this form*

Your Relationship to Student*

If your relationship is Other, please explain

Email*

Your phone number*

Please describe the student to us in a few sentences:*

Guardian's name:

Guardian's relationship to student

If Guardian is Other, please share:

Guardian's Phone Number

Guardian Email Address

Does the student currently live with their legal guardian?

Briefly tell us the current challenges the student and family are facing.*

How did you hear about Wears Valley Ranch?

From a friend

Online search

Email/Mail

Referral from Social Worker

from counselor

Other

From Richard counselor at ebenezer