Prospective Student Inquiry Form

Prospective Student Inquiry Form
Student Name
First NameMiddle NameLast Name
Birth Date
MonthDayYear
Gender
Address
Street Address
Street Address Line 2
CityState / 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 NameMiddle NameLast Name
Emergency Contact Number
Email
example@example.com
What city and state were you born in?
Do you have a high school diploma?
Upload a picture of your high school diploma or CERTIFIED high school transcript *
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Which course are you interested in?
Do you prefer day 8am to 6pm or evening 4pm to 10pm classes?
Which location are you interested in?
Have you ever been convicted of a crime?
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?
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
Clear
Date*
MonthDayYear
Date
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