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Admission Application

Program:

Cosmetology Esthetics Day Class Start Date: Massage Therapy Nail Technician Evening

Personal Information:

Name : Last NameFirst NameM.I.


SSN :

Address: SteetCityStateZip


Phone: Home PhoneWork PhoneMobile Phone


Date of Birth: Email:

Name of Parent/Guardian: Phone #: (if applicant is under 18 years of age)


Male Female         US Citizen: Yes No

If no: VISA Status Country of Citizenship:

Emergency Contact: Relationship: Phone #:


Education:

High School: NameCity & State


HS Grad Date: GED FROM: Date

Education beyond HS: NameCity & State


Degree Earned: Attended:


Employment:

Current Occupation:

Employer: NameAddress/CityPhone #


Referrences - Personal (2):

Referrence 1: NameAddressPhone


Referrence 2: NameAddressPhone


Referrence 3: NameAddressPhone


Referrences - Professional (2):

Referrence 1: NameAddressPhone


Referrence 2: NameAddressPhone


Referrence 3: NameAddressPhone


(If additional space is necessary to answer any of these questions, please attach additional pages)

How did you hear about our school?

What made you decide to join Palm Beach Academy?

Please include a brief summary of your background and motivation for entering your chosen field:

Do you see yourself practicing at one of the following?

Spa Salon Country Club Resort Cruise Spa/Salon Ownership Medical Office Atheletic Facility Private Practice/Housecalls


Do you have an employment opportunity waiting for you upon licensure?

If not, would you like us to assist you in securing an employment opportunity?

Do you have a diagnosed learning disability?

Who will be responsible for paying your tuition?


All the information provided in this application is true to the best of my knowledge. I understand that I am applying for admission to the Palm Beach Academy of Health & Beauty. I acknowledge receiving, reading, and understanding all the requirements for admission to the school including the school catalog and if accepted will comply with those requirements. I understand that a non-refundable $100 application fee is due with submission of this application for consideration. The applicant will be notified by phone, in writing, or in person of acceptance or denial of their admission application.

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Thank you for choosing the Palm Beach Academy of Health & Beauty