New Online Application

Victoria's Academy of Cosmetology

23 W 1st Ave, Kennewick, WA 99336

Online Application

Victoria’s Academy of Cosmetology does not discriminate in its employment, admissions, instruction or graduation policies based on sex, religion, sexual orientation, gender identification, age, ethnicity, disability, race, creed, financial status or area of origin or residence.

Personal Information

First Name

Last Name

Street

City

State/Province

Zip/Postcode

Home Phone

Cell Phone

Birth Date

Social Security No

Gender

Ethnicity

Are you a citizen of the United States?

Yes No Not Selected

Marital Status

Name of Spouse

Number of Children (if any)

Emergency Contact Information

Emergency Contact Name

Relationship to Student

Phone

Background Information

Have you been convicted of a felony in the past 10 years?

Yes No Not Selected

Are there any foreseeable events that may affect or impede your attendance while in school? i.e., work schedules, jail, pregnancy, court dates, lack of childcare, etc.

Yes No Not Selected

If yes, please explain:

Program Information

Program

Desired Start Date

Have you attended any college or technical school in the past?

Yes No Not Selected

Have you previously received training in any of the above fields?

Yes No Not Selected

If yes, Number of hours completed

Name and location of school attended

Dates attended: From

Dates attended: To

Are you currently enrolled there and wishing to transfer?

Yes No Not Selected

Are you currently licensed in any of the above listed fields?

Yes No Not Selected

How Long?

State

License number

Expiration Date

Referral Information

If Other (please list)

References

1. References Name

1. Reference Phone Number

1. Relationship to Student

2. References Name

2. Reference Phone Number

2. Relationship to Student

3. References Name

3. Reference Phone Number

3. Relationship to Student

PLEASE READ BEFORE SIGNING

I DECLARE UNDER THE PENALTY OF PERJURY, THAT THE STATEMENTS SUBMITTED BY ME ON THIS APPLICATION ARE TRUE AND CORRECT. ALL MATERIALS SUBMITTED BY ME FOR PURPOSED OF ADMISSION BECOME THE PROPERTY OF VICTORIA'S ACADEMY OF COSMETOLOGY. I UNDERSTAND THAT FALSIFICATION, WITHHOLDING PERTINENT DATA OR FAILURE TO REPORT CHANGES TO THIS APPLICATION MAY RESULT IN MY DISMISSAL.

Applicant Signature

Today's Date

A $100.00 ENROLLMENT FEE IS REQUIRED FOR ENROLLMENT.

-THIS FEE IS NON REFUNDABLE-

All applicants must provide the following documentation with the submission of their application. No applicant will be considered for enrollment until ALL documents are received.

1. Copy of high school diploma or G.E.D. (a certified copy of a transcript is acceptable)

2. Copy of driver license or a certified copy of birth certificate

3. Copy of social security card

Upon acceptance, applicants will be notified by mail and an orientation date will be scheduled.

Financial Aid is available for those who qualify.

Go to www.fafsa.ed.gov and fill out an application to apply for Federal Student Aid.

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