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Cornerstone Chrysalis
Candidate Application

The security and confidentiality of the information provided on this form is of the utmost importance to the Cornerstone Chrysalis Community and will be held and maintained in a secure manor.

Candidate Information

Has Chrysalis been explained to you?
The follow-up program explained?

Parent/Guardian Information

We acknowledge this is a 72 hour event and that if the candidate is unable to participate for the entire weekend experience for any reason we understand the candidates application to participate will be moved to the next available flight dates.

This is an application to participate in a Chrysalis weekend experience. Filling out this application does not guarantee acceptance. Upon acceptance you will be notified of the dates of your weekend. Please notify us IMMEDIATELY if you cannot attend since there may be a waiting list.


After submitting this application you will be taken to the Activities Emergency Medical Release Form. Your application is not complete and will not be considered for the upcoming flight without completing this form. If you have any questions or concerns you can contact the registrar at

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