ENROLLMENT APPLICATION - Hinton Barber College - Learning In Style

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OUR PROGRAM COVERS

All the rules and regulations of the industry

Health and safety standards and how to protect yourself

Disinfection and sanitation

Bacteriology, anatomy, and physiology

Analyzing hair and scalp to determine disorders

Chemical procedures

Haircutting, Hair coloring and bleaching

Scalp and hair treatments

Facial massages

Barbershop management

Communication and salesmanship

And much morel!!

Enrollment Application You must completely fill out all of this information for your application to be complete. Any documents needed will be discussed with you and your enrollment advisor.
Your Anticipated Program: *
E-mail Address: *

General Information
Anticipated Schedule: * Full Time Part Time
Name *
Address *
City *
State *
Zip *
Home Ph:
Cell Ph:
Date-of-Birth
Place-of-Birth *
Social Security # *
Sex Male Female
Drivers License or State ID # (Include State): *
Exp. Date: *

EDUCATION
Do you have a High School Diploma or GED * Yes No
Date Diploma or GED Received
High School Attended
City
Former Barber or Cosmetology school student? ? (Click if "Yes")
Name of School
Address
Hours Completed
Year Attended

OTHER SCHOOLS ATTENDED SINCE HIGH SCHOOL
Name
Address
Years Attended
Degree Granted?


Name
Address
Years Attended
Degree Granted?

EMERGENCY CONTACTS
Name
Relationship
Phone

Name
Relationship
Phone

Name
Relationship
Phone

Do you have any medical problems? (Click if "Yes" then explain below)
Explain
CONVICTIONS/FELONY'S
Have you ever been convicted of a criminal offense (other than traffic violation) * Yes No
Explain

* (initial) In connection with my application to Hinton Barber College, I understand that a consumer report, which may contain public records information, is being requested.
* I HEREBY CERTIFY THE ABOVE TO BE TRUE STATEMENTS AND UNDERSTAND THAT ANY FALSIFICATION MAY BE JUST CAUSE TO REJECT MY APPLICATION FOR REGISTRATION.

Signature * (Please Type Your Name Here)
Date * (Please Type Today's Date Here)

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* Required