| Please fill in all fields marked with a * |
 | Name |
* |
 | Address |
* |
 | City |
* |
 | State |
* |
 | Zip |
* |
 | Email |
* |
 | Home Phone |
* |
 | Cell Phone |
* |
 | Employer |
* |
 | Work Phone |
* |
 | Date of Birth |
* |
 | Social Security Number |
* |
 | Drivers License Number |
* |
 | Number of Dependents |
* |
 | Ages |
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 | How did you hear about our academy?* | * |
 | I plan to enroll in* |
Cosmetology
Nail Spa Tech
Instructor
* |
 | I would like this schedule * |
Full Time Days, M-F, 9-4:30
Part Time Days, M-F, 9-1
Part Time Evening, T-W-Th, 5-9, Battle Creek Only
* |
 | I plan to take classes at * |
Battle Creek
Portage
* |
 | I want to begin in * |
January
April
June
September
November
* |
 | Last High School |
* |
 | High School Grad Date |
* |
 | High School GED |
High School
GED
* |
 | Previous Colleges Attended |
* |
 | Have you ever had a student loan |
Yes
No
* |
 | Cosmetology School Transfer Only
Name of School |
* |
 | Transfer School Address |
* |
 | New and Transfer Students:
Do you want to apply for financial aid? |
Yes
No
* |
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