Final Application Form 2026-2027

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 Grade Level for 2026-2027 School Year:
Student's Birthday Student's Birthday / MM / DD YYYY
Student's Current School
Parent/Legal Guardian's Full Name Parent/Legal Guardian's Full Name First Last
Parent/Legal Guardian's Phone Number Parent/Legal Guardian's Phone Number - ### - ### ####
Parent/Legal Guardian's Email Address
Secondary contact: Secondary contact: First Last
Secondary contact email:
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
Has student ever been expelled from a school?

Has student ever been expelled from a school? Yes No
Does your child have an IEP?

Does your child have an IEP? Yes (email most recent IEP and Evaluation Team Report to admissions@xavierja.org) No
Does your child have a 504 Plan?

Does your child have a 504 Plan? Yes (email most recent 504 Plan and Evaluation Team Report to admissions@xavierja.org) No
Question for the parent/guardian:
Why are you applying to Xavier Jesuit Academy? (100 word limit - roughly 5 sentences)
Maximum of 100 words allowed. Currently Entered: 0 words.
Question for the student:
What are your hopes and dreams? What would it take for you to accomplish those hopes and dreams? (100 word limit - roughly 5 sentences)
Maximum of 125 words allowed. Currently Entered: 0 words.
How many people are in your household?
Household Income (prior to enrollment, families will be required to submit tax and/or pay stub documentation)
Please indicate if your family currently qualifies for:

Please indicate if your family currently qualifies for: Free lunch Reduced price lunch Neither Not sure
We require student immunizations based on the Ohio Department of Health vaccination plan. Can you commit to following these requirements?

We require student immunizations based on the Ohio Department of Health vaccination plan. Can you commit to following these requirements? Yes Other (additional records required)
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 Email Community Event Church bulletin or 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