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Thank you for your interest in South Bend Junior Academy!

Please fill out the form below, and our Admissions Office will contact you shortly to provide additional information regarding your request.

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Parent / Guardian Information
  • First Parent / Guardian
  • First Name *
  • Last Name *
  • Salutation *
  • Email Address *
  • Confirm Email Address *
  • Birth Gender
  • Work Phone
  • Cell Phone *
Home Address
  • Street Address
  • City
  • Country
  • State
  • Zip
  • Home Phone
  • How Did You Hear About Us? *
    Details:
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  • Student 1
  • First Name *
    Last Name *
  • Birthdate *
    (mm/dd/yyyy)
    Birth Gender *
  • Grade Level of Interest *
    School Year *
  • Student Interests
    Activities
  • Current School
  •  
  • Is There Another Student?
    Yes No
  •  
  • Parent / Guardian Notes
  •