Online Application

Application for Enrollment

Please complete all required fields!

(*) Indicates a Required Field
we do not discriminate against age, sex, race, sexual orientation, religion

Choose Course(*)

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Instructor "Start Date To be Determined"

Start Date:(*)

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Start Date(*)

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Class Time(*)

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Legal First Name(*)

Please type your full name.

Middle Initial

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Legal Last Name(*)

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Facebook Profile Name(*)

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Nicknames/Other Names you may go by

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D.O.B.(*)

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Cell Number:(*)

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Current Address:(*)

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City/State/Zip(*)

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Email:(*)

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Citizenship:(*)

Citizenship: United States of America
Other

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Other(*)

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Are you a U.S. Veteran?(*)

Are you a U.S. Veteran? Yes
No

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Branch(*)

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GI Bill Eligible?(*)

GI Bill Eligible? Yes
No

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Ethnicity(*)

Ethnicity Hispanic or Latino
Not Hispanic or Latino

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Race (mark one or more)(*)

Race (mark one or more) White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander

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Sex(*)

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Enrolment:

Do you plan to or have already applied for Financial Aid:(*)

Do you plan to or have already applied for Financial Aid: Yes
No

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Education

(you will need to provide proof of High School Education/GED Scores)

HS Diploma(*)

HS Diploma Yes
No

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Date of HS Graduation?(*)

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HS Name:(*)

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City/St:(*)

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GED Certificate?(*)

GED Certificate? Yes
No

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Date of Graduation/Certificate Received:(*)

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Higher Education:

Have you had any formal training in the practice of cosmetology in the past?(*)

Have you had any formal training in the practice of cosmetology in the past? Yes
No

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List any other higher education program or colleges you have attended in the past:

School Name:(*)

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Phone(*)

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Address:(*)

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City/State/Zip(*)

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Attended(*)

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To:(*)

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Hours:(*)

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Financial Aid:(*)

Financial Aid: Yes
No

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Degree or Certification:(*)

Degree or Certification: Yes
No

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Please tell us how you heard about us:

Check all that apply

Check all that apply Radio Ads
Newspaper
Facebook
Internet
Friend
Other

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Other:

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Supplemental References

Please List References. Be sure to verify addresses, fill in all information completely, and list only references with which you have continued contact.

Mother

Mothers Name

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Mothers Address

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City

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State

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Zip

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Phone Number

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Mothers Employer

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Father

Fathers Name

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Fathers Address

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City

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State

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Zip

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Phone

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Fathers Employer

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Personal Reference

Personal Reference Name

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Personal Reference Address

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City

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State

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Zip

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Phone

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Relation

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Relative Not in Your Home

Name

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Address

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City

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State

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Zip

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Phone

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Relation

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Health Form

Please check any of the following diseases or disorders that you may have, as well as any medications that you may be taking. Please note this information is optional to provide. We ask in cases of emergencies that you provide us with this information to present to any Emergency Medical Service Provider. Your information is not shared with anyone else and remains private.

Name

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DOB

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Back Conditions
High/Low Blood Pressure
Allergies
ADD/ADHD/ other mental
Ulcers/ Stomach Problem
Headaches/ Migraines

Diabetes/Hypoglycemia
Heart Conditions
Bi Polar
Epileptic
Depression
Others

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Allergies Details

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Others Details

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Please explain the nature and current treatment of any illness checked

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Are you currently taking medications?

Are you currently taking medications? No
Yes

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Name of Primary Care Physician

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Are you pregnant?

Are you pregnant? No
Yes

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Name of Obstetrician

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Emergency Contact Information

Name

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Cell

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Relation

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Work Phone

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OTHER INFORMATION

Are you under a Doctor or Nurses care that would limit your activity or interfere with your attendance?

Are you under a Doctor or Nurses care that would limit your activity or interfere with your attendance? No
Yes

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Please explain

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Signature

Name(*)

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Date(*)

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Enter Text(*)

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Submit

Application for Enrollment

Enrolment:

Education

Higher Education:

List any other higher education program or colleges you have attended in the past:

Please tell us how you heard about us:

Supplemental References

Personal Reference

Relative Not in Your Home

Health Form

Emergency Contact Information

OTHER INFORMATION

Signature

Admissions Info

Inside Headmasters

Hours & Info

School Hours: