|
Personal Information
|
|
 |
Student's First Name |
|
|
Student's Middle Initial |
|
|
Student's Last Name |
|
|
Date Of Birth |
|
|
|
|
|
Grade Entering |
|
|
Address |
|
|
City |
|
|
State |
|
|
Zip |
|
|
E-mail |
|
|
Home Phone |
|
|
Emergency Phone |
|
|
|
Parent/Guardian Information
|
|
|
Indicate to whom mail should be sent
|
|
|
Father |
|
|
Mother |
|
|
Address (if different than above) |
|
|
City |
|
|
State |
|
|
Zip |
|
|
|
Father's Employer |
|
|
Position |
|
|
Home Phone |
|
|
Business Phone |
|
|
|
Mother's Employer |
|
|
Position |
|
|
Home Phone |
|
|
Business Phone |
|
|
|
Previous Education Background
|
|
|
Elementary School / Junior High School |
|
|
Dates of Attendance |
to |
|
Date of Graduation |
|
|
Last School Attended (if transferring) |
|
|
School Address |
|
|
Number |
|
|
Street |
|
|
City |
|
|
State |
|
|
Zip |
|
|
|
Academic Information
Xaverian offers courses in French, Italian,
and Spanish. Please indicate your son's preference. Please note
that preference does not guarantee placement in that course.
|
|
|
First Choice |
|
|
Second Choice |
|
|
Third Choice |
|
|
Have you studied a Foreign Language? |
|
|
If so, how many years? |
|
|
Which language? |
|
|
Which level of math have you studied? |
|
|
Which regents, if any, are you planning on taking this june? |
|
|
Do you play a musical instrument? |
|
|
Which one? |
|
|
|
Ethnic Data
The New York State Board of Education
requires Xaverian High School to record ethnic data on each
student. Please fill out the following information.
|
|
|
Ethnicity |
|
|
Religious Affiliation |
|
|
|
other: |
|
If Catholic, what parish do you belong to? |
|
|
Do you participate in athletics? |
|
|
If so, which sport? |
|
|
|
Parental/Guardian Survey
|
|
|
To what fraternal organizations or clubs (Lions, K of C, Holy Name, etc) might you belong?
|
|
Do you have any experience in grant writing, foundation
research, or fund raising of any kind? If so, please describe:
|
|
Please list any skill, talent, or area of expertise
that you would gladly share with the Xaverian community.
|
|
|
Tuition and Fees
Tuition for the 2007-2008 school year is $9,700.00.
Along with the $ 200.00 registration
fee (which may be already paid), students are required to pay
fees for accident insurance, yearbook, examinations, retreats
and dramatics amounting to approximately $200.00. Seniors should add an additional
$200.00 for graduation fees. Tuition and fees must be paid to
date before report cards, transcripts, or diplomas will be issued.
|
|
|
|
Parental Approval
We give our son (ward) permission
to participate in the athletic activities and physical education
program of Xaverian High School and in doing so release Xaverian
High School, its Trustees, Administrators, and Faculty from
any and all liabilities and penalties that may result from any
injuries incurred during said participation. We also approve
and endorse this application for our son (ward) and in consideration
of his acceptance as a student, we hereby guarantee to Xaverian
High School the payment of his tuition and fees and other such
expenses as he may incur in account with the school, recognizing,
however, the right of the school to exclude at any time a student
whose conduct or academic standing renders undesirable his presence
in the school. We also agree to the stipulation that our son
(ward) would fulfill the religious obligation requested by the
school, and that we will also assume our parental obligation
to participate in and support each year the parental meetings
and activities of Xaverian High School.
Please note, due to the nature of this
digital document, please type your name in below to act as a
digital signature. Applications will not be processed without
a digital signature. All digital signatures will be verified
via telephone.
|
| |
|
Please
submit this form, then print and send to:
7100 Shore Road, Brooklyn, NY 11209
Attn: Admissions Office
Please Note: Your son's Immunization Record must accompany
this form.
|
|