Application Form

Thank you for your interest in submitting an application for our 4A Program, your journey to becoming a new you begins now! Once you have downloaded your application please print, complete, and return it to the Office of Intake & Recruitment in the Main Building Room 231C at the Liberty Campus.
Please note all perspective members must schedule an interview with the Intake Specialist/Recruiter. To schedule an interview please contact Mr. Stacy French at or 410-462-7704.