Full Name
Email Address
Phone Number
Cell Number
(optional)
Address
City
State
Zip Code
County
SSN
Date Of Birth
Drivers License #
Have you ever been convicted of a felony?
Yes
No
Do you currently have a cosmetology license?
Yes
No
How do you plan to pay for your education?
Personal
Loans
Grants
Prior to or on your start date, we require a payment of $250.00. This covers the cost of the kit, registration fee, and administrative fee. Would this payment affect your interest or delay your ability to start?
Yes
No
Are you right or left handed?
Right
Left
Are you currently employed?
Yes
No
If so, what is the name of your employer?
Business Phone Number: