Request Information

Let Kolob Canyon Rtc know that you are interested in learning about their school. Provide your information below to request this school's viewbook and application. Your request will typically be processed within 24 hours. If you have more specific questions for this school, please use our Email Schools form instead.

Notes for Prospective Students

All students will go through a clinical and academic acceptance. Our admissions criteria will not allow for: Medically unstable, Pregnancy, Fire Starters, Psychotic disorders, Sexual perpetrator, extreme violence toward others, and severe Autism.

Student Information

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Name of parent:

Student first name:

Student last name:

Student date of birth:

Student is:

Male

Female

Currently in grade:

Seeking entry for grade:

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About the Student

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Address and Telephone Number

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