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Program Preference:
____ Cosmetology ____ Nail Technology ___
Esthetics (check one) |
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Today's Date: |
_____________ |
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| Social Security #: |
____
- _____ - _______ |
Date of Birth: |
______________ |
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| First & Last Name: |
________________________________________________________________ |
| Address: |
________________________________________________________________ |
| City: |
________________________ |
State: |
__________ |
| Zip: |
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(AC) Phone#: |
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- ____ - ____ |
| Emergency Contact: |
_________________________________________________________________ |
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Present Employment: |
_________________________________________________________________ |
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Education Level: |
____ High
School ____ GED ___Did Not
Graduate (Please check one) |
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Name of High School: |
________________________________________________________________ |
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Scheduled class date you wish to attend: |
_______________________________________ |
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Have you ever attended college/vocational
training? |
___Yes
___No (Please check one) |
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Name & Address of college/vocational school: |
_______________________________________ |
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________________________________________________________________________ |
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Signature:
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____________________________________
Date: ________________ |
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**Note: Application
processing does not begin until application fee is received. |
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