Cadet Application

Thank you, for your interest in our program. Please fill out the information on the next two pages and submit them to our office.
Below is a list of documents we will need. Please note that a copy of those documents will be sufficient and preferred. If you have any questions concerning the application, call our Office; we will be glad to help you.

  • Birth Certificate: Copy (State issued not a hospital record)
  • Social Security Card: Copy of the signed card
  • Driver's License (if applicable)
  • Official School Transcript

We are a residential program; therefore our requirements of shots will differ from those of a public school. However, these shots are necessary for the safety of our applicants.

Shot Records:

  • PPD (Tuberculosis skin test) results within last 6 months.
  • MMR #2
  • Tetanus (must be current )
  • Meningitis

Health Insurance Card:

  • We need a copy of the front and back of the card

These immunizations are free at all County Health departments in the state of Oklahoma.

Select your Recruiter from the list:
If unknown please "unknown".

Application

 * = Required information

Applicant Information

* Last:
* First:
Middle:
* Social Security Number: (xxx-xx-xxxx)
* Date of Birth: (mm/dd/yyyy)
* Gender: Male Female
Race:
Marital Status of Applicant:
Number of Children of Applicant:
Applicant Home Phone:
Applicant E-mail:

Mailing Address:

* Street:
* City:
* County:
* State:
* Zip Code:

Parent /Legal Guardian Information

* Last:
* First:
Middle:
What is your relationship to applicant?
* Home Phone:
Work Number:
If we call your work number who should we ask for?:
E-mail:
Cell Phone:
* Home Address:
City:
County:
State:
Zip Code:
Total family size:
Yearly gross income:

School Information

Last School Attended:
City:
Last Grade Completed:
Reason for Leaving:
Have you ever taken the GED? Yes No
If so, did you pass the GED? Yes No
What date did you take the GED? (mm/dd/yyyy)
Important: Who referred you to TYA and what is their occupation?

Contact Sheet
Please give us a list of people who are authorized to be contacted and/or pick up your child in the event that we are unable to get in touch with you.
Name(s):
Relationship:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Mailing Address:
City:
State:
Zip Code:
Name(s):
Relationship:
Home Phone:
Work Ph:
Cell Phone:
E-mail:
Mailing Address:
City:
State:
Zip Code:
Name(s):
Relationship:
Home Phone:
Work Ph:
Cell Phone:
E-mail:
Mailing Address:
City:
State:
Zip Code:
Name(s):
Relationship:
Home Phone:
Work Phone:
Cell Phone:
E-mail:
Mailing Address:
City:
State:
Zip Code:

THUNDERBIRD YOUTH ACADEMY REPORT OF MEDICAL HISTORY

Applicant Name:
SSN:
Birth Date:
Parent/Guardian Names:
Home Phone:
Parent/Guardian Address:
City:
Zip:

Mom's Work Phone:
Mom's Cell:
Mom's Other Phone:

Dad's Work Phone:
Dad's Cell:
Dad's Other Phone:

IF PARENT/GUARDIAN CANNOT BE REACHED IN AN EMERGENCY CONTACT:
Name:
Phone:
Or
Other Contact Name:
Other Contact Phone 1:
Other Contact Phone 2:

APPLICANT INFORMATION

Do You Wear (check): Eye Glasses (full time)
Eye Glasses (reading only)
Contacts
Braces

DO YOU (check): Have Loss Of Hearing (right ear)
Have Loss Of Hearing (left ear)
Stutter

Current Medications:

ALLERGIES:
Medications
Food
Insect Bites/Stings
Poison Ivy / Oak:

Previous Surgeries & Age At Time Of Surgery:
Current Dr.:
Office Number:
Date Of Last Visit:

IMMUNIZATIONS must be up to date with current PPD, Tetanus, Meningitis and MMR #2. It is MANDATORY for admission to the Thunderbird Youth Academy that a copy of the applicant’s immunization record is provided. These immunizations are free at all County Health departments in the state of Oklahoma.

PLEASE CHECK ALL OF THE FOLLOWING ITEMS THAT APPLY:
Eye, ear, nose, or throat trouble
Frequent indigestion
Had 1 or more children
Paralysis (include infantile)
Chronic or frequent colds or coughs
Stomach, liver or intestinal trouble
Treated for a female disorder
Epilepsy, seizures, or fits
Severe tooth or gum trouble
Gall bladder trouble or gallstones
Change in menstrual pattern
Motion sickness
Bleeds easily
Arthritis, rheumatism, or bursitis
Recent gain or loss of weight
Frequent trouble sleeping
Liver Disorder
Diabetes
Hypoglycemia
Eating Disorder
Nose bleeds
Adverse reaction to serum or medicine
Jaundice or hepatitis
Depression or excessive worry
Skin diseases
Bone, joint or other deformity
Thyroid trouble or goiter
Loss of memory or amnesia
Seasonal Allergies (Hay fever)
Tumor, growth, cyst, cancer
Lameness or neuritis
Nervous trouble of any sort
Asthma; shortness of breath
Loss of finger, toe, arm, or leg
Rupture/ hernia
Periods of unconsciousness
Coughed up blood
Painful or "trick" knee, shoulder, elbow
Piles or rectal disease
Attempted suicide
Tuberculosis, lived w/ anyone who did
Frequent or painful urination
Recurrent back pain
Been a sleepwalker
Scarlet fever, rheumatic fever
Bedwetting since age 12
Swollen or painful joints
Dizziness or fainting spells
Palpitation or pounding heart
Kidney stone or blood in urine
Cramps in your legs or feet
Frequent or severe headaches
Heart trouble or murmur
Sugar or albumin in urine
Broken bones
Head injury
High or low blood pressure
VD- Syphilis, gonorrhea, etc.
Wear brace or back support
Anemia/ Sickle cell anemia

Explain any items circled above

MEDICAL EXPENSES STATEMENT OF UNDERSTANDING

The medical staff at the Thunderbird Youth Academy consists of Registered Nurses. They will make any medical determinations regarding scheduling appointments, administering prescriptions, etc. Additionally, one Medical Doctor is on call to assist them in the decisions regarding the health of each cadet. Thunderbird Youth Academy DOES NOT pay for normal medical expenses incurred by your cadet. The cadet, and ultimately the parent/guardian, is responsible for all normal medical and dental expenses, to include all co-payments, deductibles, and all non-covered charges. The academy will provide the physician, hospital, or pharmacy with the appropriate insurance information. If the cadet has a CDIB card, he/she will be treated at an Indian Facility, unless there is other insurance coverage. By signing this form you agree to the accuracy of the medical information provided and the Medical Expenses Statement of Understanding.

THUNDERBIRD YOUTH ACADEMY APPLICANT LEGAL INFORMATION

Applicant First Name:
Applicant Last Name:
Applicant Middle Initial:
1. Have you ever been arrested and/or charged with a crime other than a traffic violation? YES NO

2. If you answered YES to question #1 please complete the following:

Date of offense: / / (mm/dd/yyyy)
Place of offense:      City:
County:
State:
Offense/Violation:
Check one: Misdemeanor Felony
Name & Location of Court:
Penalty Imposed or Other Disposition:
Probation Officer Name & Phone Number:

Date of offense: / / (mm/dd/yyyy)
Place of offense:      City:
County:
State:
Offense/Violation:
Check one: Misdemeanor Felony
Name & Location of Court:
Penalty Imposed or Other Disposition:
Probation Officer Name & Phone Number:

3. Are you currently awaiting a hearing or sentencing? YES NO

4. If you are awaiting a hearing or sentencing, what is the scheduled date and time?

5. Are you currently on probation? YES NO