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General Information

Date:
First Name: Last Name:
Street Address:
City: State: Zipcode:
Phone Number:
Cell Number:
Work Number:
Email Address:
Birth Date: Age
Mailing Adress (if different than above)
Steet Adress:
City: State: Zipcode:

Emergency Contact Information

Contact Name:
Phone Number:
Relationship to you:

Education Information

High School Name:
City: State:
Did you graduate?
Yes
No
If yes, date:

Do you have your G.E.D?
Yes
No
If yes, date:

Name of college you attended:
Area of Study:
Did you graduate?
Yes
No
Length of time you attended:

Vocational Training:
Area of Study:
Did your graduate?
Yes
No
Length of time you attended:

Employment Information

Currently Employed:
Yes
No
If yes,
Part Time
Full Time

Start Date:
Employer Name:
Job Title:
Supervisor:
Job Description:

Past Employer:
Start Date: End Date:
Job Title:
Supervisor:
Job Description:

1. References(Name, Phone Number, Business):

2. References(Name, Phone Number, Business):


Other Information

What skills or qualitites do you currently have that will help you in your cosmetology/esthiology or nail esthetics training?

What is your financial plans for school?
Loans
Credit Card
Check
Scholarship

Is anyone helping you with finances?
Yes
No

Have you saved money for school?
Yes
No

Do you plan on working while attending school?
Yes
No

If so, where?
How many hours?

Will you be living
Independently
with Family

Will you need housing assistance?
Yes
No

When would you like to start school?

Personal Information
W e designed the following questions to give us a more in-depth look at you as an individual.

1. What specific goals other than those related to occupation have you established for
    yourself?


2. What motivates you to put forth your best effort?


3. How do you determine or evaluate success?


4. What qualities should a successful professional possess?


5. What accomplishments have given you the most satisfaction? why?


6. How do you work under pressure? How do you deal with pressure?


7. In what kind of environment are you most comfortable?


8. How did you hear about our school?


9. How would you utilize your cosmetology license?


10. Are you planning to begin your career in indiana? If no, where?


11. Is there any obstacle or circumstance that would prevent you from starting school?