Chicago Jesuit Academy Application

If you would prefer to download a paper copy of our application, or request that one be mailed to you, please click here.

Student Information
Student First Name *
Student Middle Name
Student Last Name *
Student Suffix (Jr., II, etc)
Street Address *
City *
State *
Zip *
Date of Birth (MM/DD/YY) *
What grade is your student in right now? *
What grade will your student be in next year? *
Has this student applied to CJA in the past? *
Current Elementary School
School Name *
How did you hear about CJA? *
Did you hear from a current CJA family? If so, who were they?
Please name any other schools attended during the last two years
Parent Information
Parent/Guardian 1
Name
Address
Home Phone
Work Phone
Cell Phone
Email
Parent/Guardian 2
Name
Address
Home Phone
Work Phone
Cell Phone
Email
Household Information
What adults does this student live with? *
What is their relationship to the student? *
How long has this student lived with these adults?
How many people live in this household in total? *
What language is spoken in the home?
Does the student qualify for the Federal free or reduced lunch program? *
2020 Household Income *
If above $75,000, please specify here:
Religion (optional)
Church (optional)
Ethnic Background (optional. Please check as many as you feel appropriate)
  African American
  Asian
  Caucasian
  Hispanic/Latino
  Native American
  Other
Sibling 1 Grade *
Sibling 1 Full Name
Sibling 1 School
Sibling 2 Grade *
Sibling 2 Full Name
Sibling 2 School
Sibling 3 Grade *
Sibling 3 Full Name
Sibling 3 School
Student Background
Help us understand the whole child. This will help us prepare to best serve him. Please note—none of these answers on their own will impact your student’s acceptance to CJA.
Has your child utilized counseling services, social work services or mentorship programs in the past? *
Does your child take any medications? *
Has your child experienced behavioral struggles? *
If "Yes" to any of the above, please explain:
Does your child have an IEP (Individualized Education Plan)? *
Does your child have a 504 Plan? *
Has he skipped or repeated any grades? *
If "Yes," please explain:
Please note, if your student has IEP or a 504, we have a variety of services to meet many of those needs, but will need to review those plans before making an admissions decision. Please submit your students IEP or 504 along with their grades.
Optional Parent Statement
Why do you wish for your son to attend Chicago Jesuit Academy? Help us understand your motivations.
New Note
Records Release Consent

By submitting this application, you consent to CJA requesting the following from your student's current school:
- Report cards from previous 2 years
- IEP/504 records
- Educational testing records
- Psychological testing records
- Discipline record
- Standardized test scores

Chicago Jesuit Academy Application

Student Information

Current Elementary School

Parent Information

Household Information

Student Background

Records Release Consent