Chicago Jesuit Academy Application

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? *
The first day of school for 3rd and 4th graders will be Thursday, August 25.

In addition to this form, you must also submit a copy of your student's grades for your application to be complete.
Applicants for the 5th grade must attend CJA's Higher Achievement Program (HAP) which begins Monday, June 20.

In addition to this form, you must also submit a copy of your student's grades for your application to be complete.

Transfer Applicants must attend CJA's Summer Program (CJASP) which begins Monday, June 20.

In addition to this form, you must also submit a copy of your student's grades and a copy of his most recent test scores for your application to be complete.

CJA is currently a third through eighth grade school. If you are interested in your child attending after the 2016-2017 school year, please contact Ms. Curtis at (773) 638-6103 or apply@cjacademy.org.

Current Elementary School

School Name *

How did you hear about CJA? *

Did you hear from a current CJA family? If so, who were they? (Parent & Student)

Please name any other schools attended during the last two years

Parent Information

Parent/Guardian 1

Name

Address

Employer

Position

Home Phone

Work Phone

Cell Phone

Email

Parent/Guardian 2

Name

Address

Employer

Position

Home Phone

Work Phone

Cell Phone

Email

Household Information

Student currently lives with (name) *

Student currently lives with (relationship to child) *

How long?

How many people live in this household in total? *

2018 Household Income *

If above $75,000, please specify here:

Religious affiliation (optional)

Church or Parish (optional)

Ethnic Background (optional. Please check as many as you feel appropriate)
  African American
  Asian
  Caucasian
  Hispanic/Latino
  Native American
  Other

Sibling 1 Full Name

Sibling 1 Grade

Sibling 1 School

Sibling 2 Full Name

Sibling 2 Grade

Sibling 2 School

Sibling 3 Full Name

Sibling 3 Grade

Sibling 3 School

Student Background

Note: Answers to these questions on their own will not disqualify young men from admission to CJA. The more complete our information, the better decisions we can make, and the better we can serve our students.

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 significant 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:

Optional Parent Statement

Why do you wish for your son to attend Chicago Jesuit Academy? Explain any circumstances that make your student particularly deserving of admission. Help us understand your family.

Upcoming Events

Chicago Jesuit Academy Application

Student Information

Current Elementary School

Parent Information

Household Information

Student Background