Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Date of Birth * MM DD YYYY Email * Program of Interest * Barbering Cosmetology Esthetics Esthetics 840 Instructor Manicurist Massage Therapy Emergency Contact Person - Name and Number * Parent, Spouse, etc. Additional Contact Person - Name & Number * Education - High School Name and Address * The Academy requires high school completion (diploma/transcript, GED, or HSE exam. Additional Training * List all training / colleges attended since high school. How did you hear about the academy? * Drive By / Walk In Facebook Instagram Tik Tok Billboard Google Student Referral Other Why do want to enter this career? * Preferred Start Date * Month and Year Have you been convicted of a felony? * Yes No Are you a U.S. Citizen or qualified non-citizen? * Yes No Allergies * Do you have any health or academic issues that could impact your training? * If yes, please explain Right Handed or Left Handed * T-Shirt Size? * Digital Signature - I certify that all statements made in this application are complete and true. * First Name Last Name Date MM DD YYYY Thank you for your interest in Summit Salon Academy Kokomo! We will be in touch soon!
