Xavier University Lab School Application

This is the application for lab school for the academic year.

Academic Year
Date of School Tour mm/dd/yyyy Date of School Tour mm/dd/yyyy / MM / DD YYYY
Please indicate which program your student is applying to for enrollment.
Your child must be three years of age before October 1st of the enrolled academic year.

Your child must be three years of age before October 1st of the enrolled academic year. Age 3 Age 4 Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
Lower Elementary (6-9 YRS.)

Lower Elementary (6-9 YRS.) Grade 1 Grade 2 Grade 3
Upper Elementary ( 9-12 YRS.)

Upper Elementary ( 9-12 YRS.) Grade 4 Grade 5 Grade 6
Middle School (12-14 YRS.)

Middle School (12-14 YRS.) Grade 7 Grade 8
Applicant Information
Child's First Name
Child's Middle Name
Child's Last Name
Nickname
Birth Date Birth Date / MM / DD YYYY
Gender

Gender Male Female
Is child a sibling of a current Lab School student?

Is child a sibling of a current Lab School student? Yes No
Does child have a sibling (s) who is also applying?

Does child have a sibling (s) who is also applying? Yes No
If child has a sibling(s) also applying list name(s) here:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Contact Phone
Ethnicity

Ethnicity African American Asian/ Pacific Islander Caucasian Hispanic American Indian/Alaskan Other Prefer not to respond
Other Ethnicity
Current school attending
How many years?
Child currently lives with?
Name, Age, and School Attending of Sibling #1
Name, Age, and School Attending of Sibling #2
Family Information

Parent /Guardian
Name Name First Last
Home Address of Parent/Guardian, if different than applicant Home Address of Parent/Guardian, if different than applicant
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Profession
Phone
Email
Parent /Guardian
Name Name First Last
Home Address, if different than applicant Home Address, if different than applicant
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Profession
Cell Phone
Email
Xavier University Lab School (XULS) is dedicated to having a diverse and balanced age group in each classroom. We are also dedicated to ensuring we can support children in their educational journey and to become life-long scholars. Please provide additional information as requested.
Why do you want your child to attend Xavier University Lab School?
What are your child’s strengths and interests?
What are your child’s challenges or difficulties?
Does your child have any emotional, behavioral or physical needs that the school should be aware of?
Has your child received or in need of any of the following:

Has your child received or in need of any of the following: IEP Speech/ Hearing theraphy Occupational therapy Physical therapy Other None
Please explain if you selected "Other":
If your child is accepted into XULS, please indicate below your intention for continuous enrollment:

If your child is accepted into XULS, please indicate below your intention for continuous enrollment: Age 3 Age 4 Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6
How did you hear about XULS?

How did you hear about XULS? Friends Family Current Sibling Attendance XU student/ faculty/Staff Other
Please explain if you selected "Other":
Please use the space below to share information that would provide additional insight into your child.
By checking the box I acknowledge that I am the parent/guardian of this applicant and agree that the information provided is accurate to the best of my knowledge.

By checking the box I acknowledge that I am the parent/guardian of this applicant and agree that the information provided is accurate to the best of my knowledge. There is a non-refundable application fee of $500 which does not apply towards tuition. Upon submission of this application you will be directed to our on-line payment site. Students must be toilet trained prior to acceptance.
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Xavier University Lab School Application

Xavier University Lab School Application

Please indicate which program your student is applying to for enrollment.

Applicant Information

Family Information

Parent /Guardian