Prospective Student Inquiry Form
Student Name
First Name
Middle Name
Last Name
Birth Date
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Year
Gender
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload a picture of your driver's license or state issued picture ID.
*
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Student E-mail
example@example.com
Mobile Number
In Case of Emergency
First Name
Middle Name
Last Name
Emergency Contact Number
Email
example@example.com
What city and state were you born in?
Do you have a high school diploma?
Please Select
Yes
No
Upload a picture of your high school diploma or CERTIFIED high school transcript
*
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Which course are you interested in?
Please Select
Cosmetology 1500 hr
Esthetics 600 Hours
Manicurist 600Hours
Electrology 350 or 600 hours
Instructor 1000 hours
Masterclass- is a brush-up class for currently licensed professionals
Do you prefer day 8am to 6pm or evening 4pm to 10pm classes?
Please Select
Day
Evening
Which location are you interested in?
Have you ever been convicted of a crime?
Please Select
Yes
No
Why are you interested in a career in cosmetology?
Are there any reason or restrictions that may cause you to miss class?
What is your favorite area of cosmetology?
What is your strongest area in cosmetology?
What is your least favorite area of cosmetology?
What do you feel is your weakest area in cosmetology?
Are you right handed or left handed?
Please Select
Right
Left
What are you most excited to learn about cosmetology?
Do you have reliable transportation?
Recent Head Shot
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If you could live you wildest dream....What would it be?
Signature
Date
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