STUDENT OF COSMETOLOGY

This advance application can be printed and completed to reserve a space in the class of your choice. Upon our receipt of this advance application you will be contacted to arrange a personal interview and finalize your enrollment.

Today’s Date:

Name:

Address:

Last

First

M.I.

Street Address

City

State

Zip Code

Telephone:

Home

Cellular

Date of Birth:

Social Security Number:

CLASS ENROLLMENT

 

 

PERSONAL

 

 

EDUCATION

 

 

Have  you graduated from High School:

Yes:

No:

High School Attended

Graduation Year

If not, have you completed a High School

Equivalency program:

Yes:

No:

Please Mail or Fax Your Completed Advance Application to:

Fullen School of Hair Design

1909 Broadway

Scottsbluff, Nebraska 69361

Fax: (308) 632-4793

 

 

(Classes start five times a year. Please circle your preferred enrollment choice.)