Application for Admission to Saint Ursula Academy's Educational Services Program

Applicant Information:

Applicant Name*

First Middle Last

Preferred Name or Nickname

Ethnicity*

(Please check all that apply)

African American

Asian/Pacific Islander

Caucasian

Hispanic

Native American

Other

Please list Ethnicity

Applicant Address*

Street Address City State ZIP Code

Birthdate*

School currently attending*

Student Cell Phone Number (for text messages)

Please list the student cell phone number below if you consent to receiving text messages from Saint Ursula Academy.

Public School District in which you currently reside:*

Public high school building that your daughter would attend if not enrolled in a Catholic high school:*

Are you currently an EdChoice recipient?*

Yes

If you need more information about Ohio's EdChoice Program, please click HERE.

If you are not currently participating in the Ohio EdChoice Program, do you plan to apply for next school year?*

Yes

If your family would like to be considered for financial aid from Saint Ursula Academy, you must apply by November 20, 2023. To apply for aid, please click HERE.

Educational and Diagnostic Information

Student Diagnosis:*

(for example: dyslexia, language disability, written language disability, AD/HD)

Date of Initial Diagnosis (month and year):*

Date of most recent evaluation (month and year):*

Who performed the most recent evaluation?*

Does the applicant have an ETR (Evaluation Team Report) or educational evaluation completed by a public school district?*

Yes

Please upload ETR or educational evaluation:

Drop files here or

Accepted file types: pdf, doc, word, jpeg, jpg, Max. file size: 5 GB.

Does the applicant have an educational evaluation completed by a psychologist?*

Yes

Please upload educational evaluation from psychologist

Drop files here or

Accepted file types: pdf, doc, word, jpeg, jpg, Max. file size: 5 GB.

Does the applicant have an accommodation plan?*

Yes

Please upload accommodation plan

Drop files here or

Accepted file types: pdf, doc, word, jpeg, jpg, Max. file size: 5 GB.

Does the applicant have an IEP/ISP (Individual Education Plan) completed by a public school district?*

Yes

Please upload ISP/IEP

Drop files here or

Accepted file types: pdf, doc, word, jpeg, jpg, Max. file size: 5 GB.

Does the applicant currently receive the Jon Peterson Scholarship?*

Yes

Does the applicant have an AD/HD diagnosis?*

Yes

Is there anything else you want us to know about this applicant as we consider her for the Educational Services Program at SUA?

In order to be considered for the Educational Services Program at Saint Ursula Academy, we need additional information from current teachers. Please list 2-3 teachers that we could contact who have interactions with your daughter.

Math Teacher Email*

English Teacher Email*

Tutor/Other Teacher Email

Release of Records

Saint Ursula Academy requests the following records for each student. These records are reviewed as a consideration of admittance to Saint Ursula Academy.

Report Cards for Grades 6th, 7th, and 8th (8th grade report cards after 1st Quarter/Trimester)

Attendance Records (if not included on report cards)

Discipline Records (if applicable)

Standardized Test Scores/Proficiency Test scores

Student SSID# if not on Report Card

If you attend a Catholic Grade School in the Archdiocese of Cincinnati, you will fill out a Release of Records form from your grade school. If you do not attend a Catholic Grade School in the Archdiocese of Cincinnati, your Release of Records is included on this form.*

I attend a Grade School in the Archdiocese of Cincinnati

I DO NOT attend a Grade School in the Archdiocese of Cincinnati

I am not sure if I attend a Grade School in the Archdiocese of Cincinnati.

Please make sure you select "Saint Ursula Academy" when you receive your Release of Records Authorization form from your Grade School. Completing this release allows your grade school to share the above-listed records with Saint Ursula Academy.

I authorize that the above listed records for my daughter may be sent to Saint Ursula Academy as part of the Admissions Process for Saint Ursula Academy for the 2023-2024 school year. I also authorize release of final records to Saint Ursula Academy at the conclusion of the school year.

(Please use your mouse to sign in the box below if you are using a desktop computer, or a stylus or your finger if you are using an ipad or tablet)

Are you having difficulty signing above?

Yes

By initialling below, I agree to the above conditions outlined under the "Release of Records". I also understand that SUA may request a paper copy of my signature if my child's grade school will not release my child's records without a digital signature. SUA will be in contact if this step is necessary.*

Please type the name included in the signature/initials above.*

Today's date*

Current Photo of Applicant

If you would like to upload a photograph of the student, please click on the "Choose File" button to select a file from your computer.

Max. file size: 5 GB.

#1 High School Choice*

Please list the high schools you are considering, in order of preference.

Please list other:*

#2 High School Choice*

Please list other:*

#3 High School Choice*

Please list other:*

Family Information:

Saint Ursula Academy communicates application and admissions information via phone and email. We will use the phone number and email listed in the Parent/Guardian #1 field as the primary contact.

Parent/Guardian #1 Name*

First Last

Relationship to Applicant*

Email*

Address (if different from applicant)

Street Address City State ZIP Code

Phone*

Parent/Guardian #2 Name

First Last

Relationship to Applicant

Address (if different from applicant)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Saint Ursula Academy Alumnae Information

Please indicate if any of your relatives graduated from or are currently attending Saint Ursula Academy. Note that legacy is not a requirement for acceptance to Saint Ursula Academy.

(Please click on the "+" to add multiple family members.)

Name

Relationship to Applicant

Graduation Year

Additional Information

If applicant has attended a school other than the one listed above, please name that school below and list the years the applicant attended that school.

(Example - Chicago High School, 2010-2012)

Has applicant ever withdrawn or been dismissed from an academic institution or program?*

Yes

All applicants must submit a response to ONE of the following two questions in 100 words or less. Bullet points are acceptable.

PROMPT #1 - We want to get to know you! Please share your accomplishments from grade school, involvement in activities inside or outside of school, and/or your hobbies and passions! (100 words or less. Bullet points are acceptable)

This brief description should be limited to 100 words.

I would like to type my accomplishments/involvement/hobbies/passions into this application

I would like to upload my accomplishments/involvement/hobbies/passions

I will submit my accomplishments/involvement/hobbies/passions to the Admissions Department prior to November 28

I will submit my accomplishments/involvement/hobbies/passions to the Admissions Department prior to November 3

Please type your response below:*

Please upload your file by clicking on the "choose file" button below.

Max. file size: 5 GB.

PROMPT #2 - Describe a time when you experienced a challenge or obstacle. How did you grow as an individual from this experience?

This brief description should be limited to 100 words.

I would like to type my response into this application

I would like to upload my response and attach it to this application

I will email my response to the Admissions Department before November 28.

I will email my response to the Admissions Department before November 3

Please type your response below:*

Upload response*

Max. file size: 5 GB.

By initialling below, I verify that the information provided in this application is true to the best of my knowledge.*

Application for Admission to Saint Ursula Academy's Educational Services Program for 2024-2025 School Year

PROGRAM OVERVIEW

DEADLINE--All requests for accommodations and support documents (i.e., current IEP, ISP, Accommodation Plan or 504 Plan AND a current evaluation) must be received by November 28, 2023.

A complete application for admission to the Educational Services Program includes:

Applicant Information:

If you need more information about Ohio's EdChoice Program, please click HERE.

If your family would like to be considered for financial aid from Saint Ursula Academy, you must apply by November 20, 2023. To apply for aid, please click HERE.

Educational and Diagnostic Information

In order to be considered for the Educational Services Program at Saint Ursula Academy, we need additional information from current teachers. Please list 2-3 teachers that we could contact who have interactions with your daughter.

Release of Records

Family Information:

Saint Ursula Academy Alumnae Information

Additional Information

All applicants must submit a response to ONE of the following two questions in 100 words or less. Bullet points are acceptable.