SJA Registration Form

2024-2025 STUDENT REGISTRATION

AND SCHOLARSHIP APPLICATION
To register your child(ren) for the 2024-2025 Academic Year, please complete the following information by Sunday, July 21. Late registration will be accepted from July 22 to August 15, but may incur a fee of a $50 per student.

Our scholarship application is also included as part of this process and requires a copy of the first page of your 2023 IRS Form 1040 to verify financial eligibility.

Note that this form is encrypted and your personal information will remain strictly confidential. If you have questions or concerns about this process, please contact Denise Yurchak at 215-859-8839.
TUITION
Tuition payments can be made via check or PayPal monthly (10 payments), by semester (2 payments), or for the full year (1 payment). In this form, you will select your billing frequency and provide other information which will enable us to send you a full monthly payment schedule/estimate. If you need this estimate before completing the Registration Form, please contact Denise Yurchak at 215-859-8839.

Your first invoice will be emailed to you in early August and will be due in late August.

Below please find an outline of our tuition and scholarship amounts for the upcoming year. These amounts are illustrative for a single student. Multi-student family discounts are offered with 15% off of the 2nd enrolled student and 25% off of the third (or more) student's tuition. Additional details, including income guidelines for scholarships, can also be found on our website by clicking here.

Early Elementary | Grades K-1
(Monday & Wednesday mornings only)
- REGULAR: $1,750 per year ($175 per month)
- WITH ST. BASIL SCHOLARSHIP: $1,250 per year ($125 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $1,000 per year ($100 per month)
Elementary & Middle School | Grades 2-8
(Monday, Wednesday & Friday full days)
- REGULAR: $4,200 per year ($420 per month)
- w/ST. BASIL SCHOLARSHIP: $3,200 per year ($320 per month)
- w/ST. NICHOLAS SCHOLARSHIP: $2,700 per year ($270 per month)
High School | Grades 9-12
(Monday, Wednesday & Friday full days)
- REGULAR: $4,800 per year ($480 per month)
- WITH ST. BASIL SCHOLARSHIP: $3,800 per year ($380 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $3,300 per year ($330 per month)
CURRICULUM & OTHER EXPENSES
WHAT WE PROVIDE

TEXTBOOKS

Whenever possible, textbooks are provided by Saint Justin Academy at no cost to families on a lending basis. Students are responsible for keeping their textbooks in good condition and returning them at the end of the year.

STANDARDIZED TESTS

Saint Justin Academy also covers the cost of any standardized tests that are completed by the students during the year (required in Pennsylvania for Grades 3, 5, and 8).

YOUR RESPONSIBILITY

OTHER CURRICULUM

Consumable workbooks that students will write in, and certain other curriculum (such as the online MrD Math program for Algebra and above, or supplies for electives such as iconography or martial arts) are the responsibility of each family and are not included in tuition.

However, in order to obtain preferred pricing and ensure timely delivery, Saint Justin Academy can purchase some of these items on your behalf and add the cost to your tuition invoice(s), according to the billing schedule you select (i.e. spread over 10 months). Later in this form, you will have the opportunity to select your preferred option. For items which cannot be purchased this way, we will send a separate communication with instructions on how/where to purchase.

SCHOOL SUPPLIES

General school supplies (such as paper, pencils, and folders) are also the responsiblity of each family and a list will be provided prior to the beginning of the program year so that families can make these purchases according to their preferences.

UNIFORMS

Saint Justin Academy observes a dress code restricting the style and colors of clothing our students wear during the program. We also ask that families purchase at least one uniform shirt with our logo to wear during field trips and other needs during the year. We strive to keep these costs as inexpensive as possible, and will send additional information on how to obtain these items later in the summer.

FIELD TRIPS AND OTHER EXPENSES

Periodically, there may be additional fees for optional items such as field trips, special events, and other miscellaneous items. These will be communicated and collected separately when needed and are not included in tuition fees.

HOMESCHOOL EVALUATOR FEES

At the end of the academic year, Saint Justin Academy will arrange for a Homeschool Evaluator to come onsite and meet with students, per Pennsylvania's requirements. There is a fee of approximately $50 per student, payable to the evaluator, which is due at the time of the evaluation and not included in tuition.
Page 1 of 6

PARENT/GUARDIAN INFORMATION
Is your family new to SJA this year?*

YesNo
1st Parent/Guardian Name*

PrefixFirst NameLast NameSuffix
Preferred Name
Nickname or Preferred Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*

Area CodePhone Number
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail*
Occupation
Occupation
Employer
Employer
Highest Level of Education
Education
Degree
Degree
2nd Parent/Guardian Name

PrefixFirst NameLast NameSuffix
Preferred Name
Nickname or Preferred Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
E-mail
Occupation
Occupation
Employer
Employer
Highest Level of Education
Education
Degree
Degree
Page 2 of 6

Information for Child 1
Name of Student 1*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2024*
Birth Date*

MonthDayYear
Gender:*
If student is 8th-12th grade, please provide their e-mail and cell phone (if applicable):
Student 1 E-mail
Student 1 Cell Phone Number

Area CodePhone Number
Medical Needs for Child 1
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he or she receives.*
Add another child?*

NoYes
Page 3 of 6 (Child 1)

Information for Child 2
Name of Student 2*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2024*
Birth Date*

MonthDayYear
Gender:*
If student is 8th-12th grade, please provide their e-mail and cell phone (if applicable):
Student 2 E-mail
Student 2 Cell Phone Number

Area CodePhone Number
Medical Needs for Child 2
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
Add another child?*

NoYes
Page 3 of 6 (Child 2)

Information for Child 3
Name of Student 3*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2024*
Birth Date*

MonthDayYear
Gender:*
If student is 8th-12th grade, please provide their e-mail and cell phone (if applicable):
Student 3 E-mail
Student 3 Cell Phone Number

Area CodePhone Number
Medical Needs for Child 3
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
Add another child?*

NoYes
Page 3 of 6 (Child 3)

Information for Child 4
Name of Student 4*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2024*
Birth Date*

MonthDayYear
Gender:*
If student is 8th-12th grade, please provide their e-mail and cell phone (if applicable):
Student 4 E-mail
Student 4 Cell Phone Number

Area CodePhone Number
Medical Needs for Child 4
Does your child have any medical/emotional problems of which we should be aware?*
Please explain your child's medical/emotional needs here*
Does your child have any allergies?*
Please describe your child's allergies here*
Is your child on any regular medication?*
Please list your child's regular medications here.*
Does your child receive extra help outside the classroom at his/her secular school? (i.e. IEP, speech therapy, reading resource, etc.)?*
Please explain the type of help he/her receives here.*
If you wish to enroll more than 4 students, please complete this application for the first four and complete an additional application as necessary.
Page 3 of 6 (Child 4)

SCHOLARSHIP APPLICATION
Our goal is that that no family should lack access to our program due to finances. Thanks to the generosity of our benefactors, Saint Justin Academy is able to offer income-based scholarships with minimal paperwork requirements. If you wish to apply for our scholarship program, please indicate this below and attach a copy of the first page only of your IRS Form 1040 for the 2023 tax year. (This can be a photo or PDF document)

If you are unable to attach it at this time, please be sure to email it to us at office@saintjustinacademy.org no later than July 25th.

NOTE: This form is encrypted and your information will be kept in the strictest confidence!
Do you wish to apply for our income-based scholarship program?*

YesNo
Please upload Page 1 of your IRS Form 1040 for tax year 2023 here:

Browse Files

Cancelof
Page 4 of 6

PAYMENT OPTIONS
Please choose your preferred billing frequency:*

Pay annual tuition in fullPay by semester (two equal payments in August and January)Pay monthly (10 equal payments August through May)
Would you like to be included in our bulk curriculum purchase program?*

YES - Please purchase consumable books on our behalf and add the cost to our tuition invoices according to our payment schedule above (in full, by semester, or monthly)NO - We will purchase our own curriculum which correspond to the SJA program assignments. We understand that we will be responsible for ensuring that these books are obtained in a timely manner to avoid disruptions.Other
Credit Card Offset Donation
Like any other organization allowing credit card use, we incur processing fees. To help offset these costs you can voluntarily donate an amount equal to 2.5% of your tuition obligations to help defray these costs. We thank you for your generosity!

Please charge my card an additional 2.5% to offset the cost of credit card processing fees.
Additional Comments
Do you have any additional comments you would like to make about your Registration or Scholarship Application?
Page 5 of 6

EMERGENCY & MEDICAL INFORMATION
If an emergency should arise, every effort will be made to notify the parents or someone designated by them if a child should become very ill or be involved in an accident. If this cannot be done, our policy is to transport the child to the nearest emergency hospital.

In the space below, please provide additional Emergency and medical contact information for your child(ren).
Name of Relative*
Relationship to Student (grandparent, aunt/uncle, etc.)*
Phone Number of Relative*
Name of Neighbor/Friend*
Phone Number of Neighbor/Friend*
Doctor/Medical Group Name*
Phone Number of Doctor/Medical Group *
Insurance Company Name*
Phone Number of Insurance Company*
PERMISSION SLIP
I hereby grant permission for my child/children to participate in Saint Justin Academy activities and events and to release Saint Justin Academy and its representatives from all liability arising out of my child's participation.

Please check "Yes" or "No" to provide your consent.
Required field*

YesNo
MEDIA ACKNOWLEDGMENT
I further grant permission for Saint Justin Academy to use my child’s image and voice in printed & electronic materials, with the knowledge that no last names will be used on a public document.

Please check "Yes" or "No" to provide your consent.
Required field*

YesNo
Authorize your consent by typing the name of one parent or guardian here:*
THANK YOU!

We look forward to working with you to educate your children!

We will be in touch in the coming weeks
with your payment schedule/estimate, first invoice,
and instructions for ordering other supplies,
curriculum, and uniforms.

If you have any questions in the meantime,
please contact Denise Yurchak or Kh. Elizabeth Bushelli.
Should be Empty:

2024-2025 STUDENT REGISTRATION

TUITION

CURRICULUM & OTHER EXPENSES

WHAT WE PROVIDE

YOUR RESPONSIBILITY

PARENT/GUARDIAN INFORMATION

Information for Child 1

Medical Needs for Child 1

Information for Child 2

Medical Needs for Child 2

Information for Child 3

Medical Needs for Child 3

Information for Child 4

Medical Needs for Child 4

SCHOLARSHIP APPLICATION

PAYMENT OPTIONS

Credit Card Offset Donation

Additional Comments

EMERGENCY & MEDICAL INFORMATION

PERMISSION SLIP

MEDIA ACKNOWLEDGMENT

THANK YOU!