Student Application online form

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STUDENT APPLICATION

Please complete this online form below and then click submit.
Personal Information
Full Name: *

First Name Last Name
Date of Birth: *

Month Day Year
E-mail: *
Mobile Number: *

Area Code Phone Number
Home Number: *

Area Code Phone Number
Birth place:
City, Country
Home Address: *

Street Address

Apt #

City State / Province

Postal / Zip Code Country
Do you have Social Security? *

Yes No
If YES, please type your # in this box.
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Employment
Do you have your own transportation vehicle? *
What language(s) are you fluent in? *
English, Spanish, Vietnamese, etc.
Are you currently employed somewhere? *
If yes, what is the name of the business?
Work Number:

Area Code Phone Number
Education
Do you have a high school diploma, GED, or euivalent to a HS diploma? *
If yes, from where?
Name of Educational Institution
Educational Institution's Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
What year did you graduate on?
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Applying for Course
Applying for Course: *

Cosmetology Instructor (English class) Instructor de Cosmetologia (clase en Español) Cos-Refreshment course Nail Technology course Cosmetology Operator (English class) Cosmetologia (clase en Español)
Are you a transfer applicant

Leave blank if you are not transferring hours from another beauty institution.
Are you a transfer applicant from another beauty institution? *
If yes, please type the name of the institution(s) and state(s) you have attended?
Name of Institution, State
Which beauty course program did you begin and did not complete?
When did you start that program?

Month Day Year
When were you dropped from the program?

Month Day Year
How many hours did you complete?
What is your state permit #?
Emergency Contact Information
Full Name (Contact #1): *

First Name Last Name
Relationship: *
Home Number: *

Area Code Phone Number
Mobile Number:

Area Code Phone Number
Work Number:

Area Code Phone Number
Full Name (Contact #2): *

First Name Last Name
Relationship: *
Home Number: *

Area Code Phone Number
Mobile Number:

Area Code Phone Number
Work Number:

Area Code Phone Number
How did you hear about us?
Please select one of the options. *

from a friend or relative from a current or former student from a current employee from a flyer from the school's website from Yelp from Google
The information I have provided is complete and correct to the best of my knowledge. If my application is accepted, I agree to abide by the policies, rules and regulations at any course to which I am admitted. I authorize B1 Careers Beauty School to verify the information I have provided. I further understand that the information submitted herein will be relied upon by the officials of the B1 Careers Beauty School in determining my admission and residency status for my enrollment eligibility purposes and that submission of false information is grounds for rejection of my application, withdrawal of acceptance, cancellation of enrollment, and/or disciplinary action.
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STUDENT APPLICATION

Personal Information

Employment

Education

Applying for Course

Are you a transfer applicant

Emergency Contact Information

How did you hear about us?