Initial Application Form

To apply online, please complete the application below.

To request a paper copy of this application, please email admissions@xavierja.org

Student's First Name
Student's Last Name
Student's Current Grade Level (2023-2024)
Student's Current School
Student's Birthday Student's Birthday / MM / DD YYYY
Parent/Legal Guardian's Full Name Parent/Legal Guardian's Full Name First Last
Parent/Legal Guardian's Email Address
Parent/Legal Guardian's Phone Number Parent/Legal Guardian's Phone Number - ### - ### ####
Parent/Legal Guardian's Mailing Address Parent/Legal Guardian's Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student lives with:

Student lives with: Both parents Mother Father Other
Please indicate if your family currently qualifies for:

Please indicate if your family currently qualifies for: Free Lunch Reduced Price Lunch Neither Not sure
How did you learn about Xavier Jesuit Academy?

How did you learn about Xavier Jesuit Academy? Lawn signs Social Media (Instagram, Facebook, etc) Mail or E-mail Community event Church bulletin/newsletter Friend or family Teacher or Coach Other
Please note that submitting an application for enrollment does not guarantee your child’s admittance to Xavier Jesuit Academy. Enrollment is complete when the family is formally accepted (in writing) and returns a completed tuition contract to the school.

Parent/Legal Guardian's initials:
Today's date Today's date / MM / DD YYYY