Online Enrollment ApplicationProgram of Interest*- Select One -CosmetologyBarberBarber Crossover (Licensed Cosmetologists Only)Month You Plan to Start Training?*Legal Name* First Middle Last Permanent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Gender*Date of Birth* Cell Phone*Phone Carrier*(Verizon, Sprint, etc...)Social Security Number*Driver's License Number*State / #Right or Left Handed?*- Select One -RightLeftRace*- Select One -CaucasianAfrican AmericanAsianAmerican IndianHispanicUnknownTwo or moreOtherOptional - for statistical purposes onlyEmail Address* EmployerIf applicableEmployer PhoneEducation*- Select One -High SchoolGEDHomeschoolSome CollegeCollege DegreeMarital Status*- Select One -SingleMarriedSeparatedDivorcedWidowedPreviously Attended College/University/Online College/Cosmetology or Barber SchoolNameDates Have you been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution in this state, or of the United States, whether or not sentence was imposed?*YesNoNOTE: This includes Suspended Imposition of Sentence, Suspended Execution of Sentence, misdemeanor and felony convictions, and alcohol related offenses, i.e. DWI and BAC.If yes, attach a statement of the details regarding all applicable charges, sentences, judgments and any restitution or rehabilitation that applies. Also include date of conviction and/or pleading, nature of offense, court location and case number. (A reported criminal offense does not necessarily disqualify an applicant from admission.)Statement of Details Regarding Charges*References #1*NameAddressPhoneRelationship References #2*NameAddressPhoneRelationship References #3*NameAddressPhoneRelationship I hereby give the Academy of Hair Design permission to use my personal information for the purpose of determining my financial aid eligibility. I understand this information may be compared with data obtained during my interview, on my FAFSA and/or on my NSLDS report. In the event inconsistencies are found they will need to be addressed and resolved prior to pursuing enrollment. I understand, also, the Academy of Hair Design may use my personal information for background check purposes.By completing/submitting this form, this constitutes your express written consent to be called and/or texted by Academy of Hair Design at the number(s) you provided, regarding furthering your education. You understand that these calls may be generated using an automated technology.The Academy reserves the right to withdraw any offer of enrollment or consideration for admission upon finding falsification, misrepresentation, or omission of fact on an application, other attachments, or in verbal statements, regardless of when it is discovered.Applicant Signature*Date* NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.