ENROLLMENT APPLICATION apply now formFirst NameLast NamePhone (Required)Phone Provider CompanyEmail (Required)Planning to Start Month– Select –JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberPlanning to attend (Required) Full Time PartimeAddressStreet AddresAddress Line 2CityStateZip CodeCampus (Required)– Select –Crystal LakeElginRockfordSchaumburgProgram (Required)– Select –Barber ProgramCosmetology ProgramEsthetics ProgramInstructor ProgramStudent InformationAre you a: (Required) U.S. citizen Permanent Resident OtherAre you married? (Required) Yes NoDo you have kids? (Required) Yes NoAre you a U.S. Veteran? (Required) Yes NoAre you right or left handed? (Required) Right LeftEducational, Demographic & Financial Assistance DataAre you a High School Graduate or GED Graduate? (Required) High School Graduate GED Graduate OtherYear of High School Graduation:Name of High School:Year you received a GED:Name of GED Issuer:Have you previously attended any post-secondary school or college? (Required) Yes NoDid you receive a Bachelor’s Degree? Yes NoComplete this part if you are interested in Federal Financial Aid.Are you interested in Financial Aid? Yes NoHave you submitted a FAFSA Application? Yes NoHave you ever had a student government loan? Yes NoIf so, are you current with your student loans? Yes No The following information will be used for reporting purposes only Demographic Area: Urban SuburbanSchool distance: Less than 10 miles 10 – 20 milesRacial/Ethnic Category: Asian Hispanic African American Caucasian Other Emergency Contacts FirstLast NameRelationship #1Phone #1FirstLast NameRelationship #2Phone #2Please List Any Medical Conditions or Medications that we need to be aware of: I have read and understand the admission application. I certify that information given within is correct and complete. I understand that false or misleading information given in my application may result in discharge. I understand, also that I am required to abide by rules and regulations of the Cosmetology and Spa Academy. I have been aware before my enrollment that a copy of the Student Catalog can be found at https://cosmetologyandspaacademy.edu/consumer-disclosures/ and I can receive one free printed version from admission office per my request. Date / Time (Required)Student’s Signature Student’s Signature Parent name and signature (if applicable) Parent name and signature EmailI understand & agree. By checking this box, I agree to receive SMS messages about educational and customer care messesage from Cosmetology & Spa Academy at the phone number provided above. The SMS frequency may vary. Data rates may apply. Text HELP for assistance. Reply STOP to opt out of receiving SMS messages. Please review our privacy policy and Terms & condition. Visit our privacy policy Terms & condition. SMS Terms and conditionsSubmit
