SJA Registration Form

2025-2026 STUDENT REGISTRATION

AND SCHOLARSHIP APPLICATION
To register your child(ren) for the 2025-2026 Academic Year, please complete the following information by Friday, April 25 (Bright Friday) for returning students or by by Sunday, June 1 (Feast of Saint Justin) for new students. Late registration will be accepted from June 1 to July 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 2024 IRS Form 1040 to verify financial eligibility. If you do not have your 2024 return yet, you can submit it separately.

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. Future months will be due by the 25th of the month.

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.

Kindergarten
(Monday & Wednesday mornings only)
- REGULAR: $1,925 per year ($193 per month)
- WITH ST. BASIL SCHOLARSHIP: $1,425 per year ($143 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $1,175 per year ($118 per month)
Elementary & Middle School | Grades 1-8
(Monday, Wednesday & Friday full days)
- REGULAR: $4,620 per year ($462 per month)
- w/ST. BASIL SCHOLARSHIP: $3,620 per year ($362 per month)
- w/ST. NICHOLAS SCHOLARSHIP: $3,120 per year ($312 per month)
High School | Grades 9-12
(Monday, Wednesday & Friday full days)
- REGULAR: $5,280 per year ($528 per month)
- WITH ST. BASIL SCHOLARSHIP: $4,280 per year ($428 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $3,780 per year ($378 per month)
NOTE: High School students also have the option of enrolling in individual classes a la carte. If you wish to enroll a la carte, please contact us to discuss scheduling and fees.

NEW! OPTIONAL Tuesdays & Thursdays | Grades 1-12
(Non-instruction tutoring, supervised study hall & activities; full or half-days)

FULL DAYS:
- REGULAR: $1,500 per year ($150 per month)
- WITH ST. BASIL SCHOLARSHIP: $1,000 per year ($100 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $750 per year ($75 per month)
HALF DAYS:
- REGULAR: $750 per year ($75 per month)
- WITH ST. BASIL SCHOLARSHIP: $500 per year ($50 per month)
- WITH ST. NICHOLAS SCHOLARSHIP: $375 per year ($38 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) 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 will purchase 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).

New for 2025-2026: Income-based scholarships will be provided to help defray the cost of books and materials. These will be aligned with the St. Basil and St. Nicholas scholarship levels with award amounts as follows:
- Kindergarten: $75 or $150 per year
- Grades 1-12: $150 or $300 per year
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 5

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

YesNo
Does your family have any interest in PK-4 (early Kindergarten for 4 year olds)? We are currently exploring this option.*

YesNo
If you have High School students to enroll (Grades 9-12), please indicate if you are planning to enroll for our usual Mon/Wed/Fri program or just 1+ classes a la carte.*

Mon/Wed/Fri High SchoolHigh School Classes A La CarteN/A (Not enrolling for High School)
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 5

Information for Child 1
Name of Student 1*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2025*
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 5 (Child 1)

Information for Child 2
Name of Student 2*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2025*
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 5 (Child 2)

Information for Child 3
Name of Student 3*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2025*
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 5 (Child 3)

Information for Child 4
Name of Student 4*

First NameMiddle NameLast Name
Preferred Name
Nickname or Preferred Name
Grade in September 2025*
Birth Date*

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

Area CodePhone Number
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 5 (Child 4)

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:

2025-2026 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

SCHOLARSHIP APPLICATION

PAYMENT OPTIONS

Additional Comments

EMERGENCY & MEDICAL INFORMATION

PERMISSION SLIP

MEDIA ACKNOWLEDGMENT

THANK YOU!