St. Andrew Academy Student Application Form

Student Information

First Name *

Last Name *

MI

Address 1 *

Address 2

Phone

Email Address

City *

State *

Zip Code *

Marital Status *

Residence Status *

US Citizen

US Permanent Resident

International Student

Current Residential Housing Situation *

Rent a house or apartment

Live in a house or apartment with family

Live in group home with others

Other / Comments - Please describe below: Other / Comments - Please describe below:

Transportation Needs to Academy Location in Livonia Michigan *

I will arrange my own transportation to the Academy

I will use public transportation to the Academy

I need arranged transportation to the Academy

I need financial assistance with transportation to the Academy

Other / Comments - Please describe below: Other / Comments - Please describe below:

Are Any Physical Accomodations Needed? *

Mobility: Handicap Access to Facility / Wheelchair Ramp

Low Vision: Need Screen Reader or other Visual Accomodation

Audio: Closed Captions and American Sign Language Interpreter

Visual Handicap: Need Braille and All Text to Audio Translation

None

Other - please describe below: Other - please describe below:

Are you a currently registered with Michigan Rehabilitation Services? *

Yes

No

Academic Background: High School / Secondary School

High School Name *

City *

State *

GPA *

Any Advanced Placement Classes (please list) *

Please list any awards or honors that you have received. *

Academy Background: Higher Education

University or Community Colleg Name *

City *

Declared Academy Major or Academy Focus (if not formally declared) *

Degree Earned *

Grade Point Average *

Years / Terms Completed *

No Higher Education Completed

0-1 Year or 1-2 Academic Terms Completed

1-2 Years or 3-4 Academic Terms Completed

3-4 Years or 5-6 Academic Terms Completed

5-6 Years or 7-8 Academic Terms Completed

Other - please describe below: Other - please describe below:

Religious Affiliation / Interest

Religious Affiliation *

Primary Parish, Church or Synagogue Name *

City

State

I am Interested in the Spiritual Growth Program as part of this Academy? *

Yes

No

Employment History

Previous Employment History (please list with most recent jobs first):

	Employer	Position	Start and End Dates
Most Recent	Employer	Position	Start and End Dates
Previous 1	Employer	Position	Start and End Dates
Previous 2	Employer	Position	Start and End Dates

Other Information

Please list any sports, extracurricular, or community service activities you regularly participate in.

Please list any leadership roles you have had

Resume or Background Summary: Please Upload Here