A Real Beauty College Enrollment Application

Please fill out this form, all fields with an * are required

*First Name:
Middle Initial:
*Last Name:
*Street Address:
*City:
*State:
*Zip Code:
*Phone Number:
*Email Address:
*Date of Birth: (Month/Day/Year)
Are you a U.S. Veteran or Dependent/Spouse of a U.S. Veteran? Yes
No
*Citizenship: United States
Other
If not a U.S. Citizen, Alien Number A:
*Marital Status: Single
Married
Seperated
Divorced
Widowed
Number of Dependents:
*Housing during Enrollment: With Parents
On my own (Renting/Buying)
*Ethnic Group (Information required for statistical reporting to government agencies): American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Pacific Islander
White
*Educational Data: High School Diploma
G.E.D.
Did Not Graduate
Post-Secondary
AA
BA/BS
MA/MS
PH.D.
Last School Attended:
Graduation Date:
*Financial Aid History: Have you ever received Financial Aid? Yes
No
If yes, do you owe a refund or did you default on a loan?
How did you hear about our college?
*What course of study are you interested in enrolling? Barbering
Cosmetology
Esthetician/Skin Care
Manicurist/Nail Care
Barbering Crossover
Cosmetology Crossover
Barber Instructor
How soon would you like to start?
*Attendance: Full-time
Part-time
*State Licensure Exam Question: Have you ever been convicted of a Felony? No
Yes
If yes, please list violation, date, circumstances, penalty & location of offense and conviction:
*Are you currently on probation or parole? No
Yes
If yes, please list name of Parole Officer:
Males: Registered for Selective Service? No
Yes
Females: Are you expecting? No
Yes
*Emergency Contact Name:
*Emergency Contact Relationship:
*Emergency Contact Phone Number:
*Emergency Contact Address:
*Applicants Initials:
*Date: