COLLEGE OF HAIR DESIGN
APPLICATION FORM
Please complete application form by printing in ink or typing.
Name(last)________________________(first)__________________(middle)_________________
Mailing Address_________________________________________________________________
Town____________________________________State________________Zip_______________
Phone________________________SS#______________________Birth date________________
Marital Status_______________________Spouse's Name________________________________
What race/ethnic group do you consider yourself to be?
_____White/Caucasian _____Black/African American _____Hispanic
_____American Indian/Alaskan _____Asian/Pacific Islander __________________Other (explain)
Have you been incarcerated in the past 12 months?_____If so, give month and year of the most
recent incarceration____________________________
I am _____Right-handed _____Left-handed
In emergency notify____________________________Phone_____________________________
Circle highest grade completed 9 10 11 12 GED Other___________________________
List schools attended
____________________________________________________________________________
____________________________________________________________________________
List previous employers and type of work
____________________________________________________________________________
____________________________________________________________________________
Father________________________________Occupation______________________________
Address_____________________________________________________________________
street town state zip phone
Mother________________________________Occupation_____________________________
Address_____________________________________________________________________
street town state zip phone
Application is for class beginning__________________________________________________
I hereby deposit_______________________________________________________________
The remainder is to be paid: Monthly______________Cash_____________Other____________
If I am accepted as a student I agree to diligently apply myself to the lessons, to practice the
procedures, to obey the rules of the school, and to live up to the highest standards in work
and conduct to the best of my ability.
I certify that all statements on this application are true and correct.
Applicants's signature_________________________________________Date______________
If applicant is under eighteen his/her parents must sign the application.
Parent signature______________________________________________Date_____________