New Student Enrollment

Student 1

*Last Name*First NameMiddle NamePreferred Name*Date of Birth*Grade Level Applying For*Gender*Ethnicity*E-Mail*Original Application Year*Choosing to Pay Registration:

*Church Affiliation*Date You Joined (mm/dd/yyyy)*Tell us about your volunteer work with your Parish or School*Please share information about your previous school or if never attended another school, indicate N/A

Do you have children enrolled at St. Francis Xavier School?*Siblings at SFXSibling 1Sibling 1 GradeSibling 2Sibling 2 GradeSibling 3Sibling 3 GradeSibling 4Sibling 4 Grade*Does your child have any allergies? If so, please specify below:

*How did you hear about St. Francis Xavier School?

St. Francis Xavier School works to individualize student learning as much as possible. Please indicate below any Academic Plan your child requires.IEP Service PlanIntervention PlanAccommodation PlanSpeech PlanOtherNo Academic Plan

Please complete the information below if your child will be attending Preschool in the coming year. Additionally, please select the scheduled time you prefer. Note that the preschool schedule in based on whether your child will be attending as "3", "4" or "5".Attending Preschool this yearPreschool Schedule

Student 2

Student 3

Student 4

Student 5

Primary Family Information

Address Line 1Address Line 2CityStateZIP Code*Home PhoneHome ListedCell PhoneCell Listed

Please copy and past the link below into a new window to pay the non-refundable $175.00 registration fee now. If you would prefer, you may submit a check for this fee to the school office.https://secure.accessacs.com/access/oglogin.aspx?sn=10652&f=2020PLEASE NOTE THAT COMPLETION OF THIS APPLICATION AND PAYMENT OF THE REGISTRATION PROCESSING FEE DOES NOT GUARANTEE YOUR ACCEPTANCE INTO THE SCHOOL OR PRESCHOOL PROGRAM. YOU WILL BE CONTACTED DIRECTLY REGARDING THE RESULT OF YOUR APPLICATION. PLEASE CONTINUE YOUR APPLICATION AND SUBMIT!

Please note you will need to provide the following information to the St. Francis Xavier School Office._____ Photocopy of the student's baptismal certificate_____ Photocopy of the student's state birth certificate (NOT mother's copy)_____ Health Form_____ Registration Fee_____ Permanent Record Card_____ Please make sure you indicate your preferred e-mail address by using it as the "home" email on the next page._____ Make an appointment with Fr. Tony Sejba (you may call 330-725-4968 to schedule)_____ Academic Record from your previous school is required

Parent 1 Information

*Last Name*First NameMiddle NamePreferred NameDate of Birth*Marital StatusSuffixTitle*Church AffiliationGenderRaceHome E-MailCell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 2 Information

*Last Name*First NameMiddle NamePreferred NameDate of Birth*Marital StatusSuffixTitle*Church AffiliationGenderRaceHome E-MailCell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Secondary Family Information

Address Line 1Address Line 2CityStateZIP Code*Home PhoneHome ListedCell PhoneCell Listed

Please copy and past the link below into a new window to pay the non-refundable $175.00 registration fee now. If you would prefer, you may submit a check for this fee to the school office.https://secure.accessacs.com/access/oglogin.aspx?sn=10652&f=2020PLEASE NOTE THAT COMPLETION OF THIS APPLICATION AND PAYMENT OF THE REGISTRATION PROCESSING FEE DOES NOT GUARANTEE YOUR ACCEPTANCE INTO THE SCHOOL OR PRESCHOOL PROGRAM. YOU WILL BE CONTACTED DIRECTLY REGARDING THE RESULT OF YOUR APPLICATION. PLEASE CONTINUE YOUR APPLICATION AND SUBMIT!

Please note you will need to provide the following information to the St. Francis Xavier School Office._____ Photocopy of the student's baptismal certificate_____ Photocopy of the student's state birth certificate (NOT mother's copy)_____ Health Form_____ Registration Fee_____ Permanent Record Card_____ Please make sure you indicate your preferred e-mail address by using it as the "home" email on the next page._____ Make an appointment with Fr. Tony Sejba (you may call 330-725-4968 to schedule)_____ Academic Record from your previous school is required

Parent 3 Information

*Last Name*First NameMiddle NamePreferred NameDate of Birth*Marital StatusSuffixTitle*Church AffiliationGenderRaceHome E-MailCell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Parent 4 Information

*Last Name*First NameMiddle NamePreferred NameDate of Birth*Marital StatusSuffixTitle*Church AffiliationGenderRaceHome E-MailCell PhoneCell ListedCompany NameBusiness PhoneExtensionJob TitleIs Emergency ContactBusiness E-MailIs Allowed to Pickup

Contact Information (Other than parents)

Contact 1

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhoneCell PhonePickup Notes

Contact 2

Contact 3

Medical Contacts

PhysicianPhysician Phone NumberDentistDentist Phone NumberHospitalHospital Phone NumberInsuranceInsurance Phone NumberPolicy Number

Finished

Confirmation E-Mail address:

Please press the save button to submit the new student application.

Date of Last Upload: Thursday, April 25, 2024 Student Enrollment Form

Student 1

Primary Family Information

Parent 1 Information

Parent 2 Information

Secondary Family Information

Parent 3 Information

Parent 4 Information

Contact Information (Other than parents)

Contact 1

Medical Contacts