Last name:
First name: Middle name:
Phone: -- Use format:111 222 3333
E-Mail Address:
Verify E-Mail Address:
Social Security Number (optional):
Religious Affiliation (optional):
List any relative who has graduated from Xavier University and/or Edgecliff College or those who currently attend Xavier. Use format: Name, Relationship, Year of Graduation
To what other colleges are you applying? (optional)
I am interested in learning more about the following scholarships: Army ROTC minority Performing Arts (art, drama, music)
Do you wish to live on campus? Yes No
Who/what prompted you to apply to Xavier University: Alumni Admission Counselor Campus Visit High School Coach XU Coach Current student High School Counselor Xavier Literature Phone Call Web site
If an Ohio resident, in what county do you live:
Certification and Signature
By typing my name in the box below, I understand that the information contained in this application is true and accurate to the best of my knowledge. Should there be a change in my high school enrollment status, I will notify the office of admission of this change prior to registering for fall classes. I also understand that all falsification and omission to the application will disqualify me from further consideration and or prompt withdrawal of any offer of admission and possible scholarship opportunities.
