Lubbock Hair Academy
                                                     Enrollment Application


This application is designed for the staff of Lubbock Hair Academy to get to know the applicant.  The
information from this application will help the staff learn the intentions, attitudes, and desires of the
prospective student in attending this institution.  



Full Name:  _________________________________________________________
               FIRST                        MIDDLE                        LAST

Address:  ___________________________________________________________

City:  ______________________     State:  __________       Zip:________________

How long at your present address?  _______________

Phone:  (       )  ____________________________

What was your previous address: __________________________________________

How long at your previous address:  _______________________


Birth Date:  ________________________       Birth Place:  ____________________

Are you a citizen of the United States?  ________
If “no” give name of country.  _______________

Social Security Number:  ____________________________________

Education Background

Date you expect to enroll:  __________________________________

Education        Name of School        Year Completed        Graduate        Type of Course

High School__________________________________________________________________

College_________________________________________________________________

Other___________________________________________________________________

If you did not graduate from high school, do you have a GED?   Yes____   No_____

Military Record:  Branch____________  Entry Date_______ Date Discharged_________

Please describe your duties and any special training you received.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________

Personal References
Please list three(3) personal references other than family members.

Name:                        Address:                Telephone:                Occupation:

___________________________________________________________________________


___________________________________________________________________________


___________________________________________________________________________



Personal Information
Please answer the following questions honestly.  Lubbock Hair Academy seeks out prospective
students that are motivated and interested in entering the hair/nail career.
Lubbock Hair Academy seeks to select qualified students without regard to race, creed, religion, sex,
age, national origin or disability.

Marital Status:     ____ Single     ____Married     ____Separated     ____Divorced

Have you ever been convicted of a crime, excluding misdemeanors?  ____Yes  ____ No

If yes, please describe in full.
_________________________________________________________________________________
_________________________________________________________________________________
_____________________________________________________

Person to be notified in case of emergency:

________________________________________________________________________
Name                                        Address                                        Telephone #

 Tell us about yourself.  



_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________
Please give any additional information that you wish to be considered in the decision to admit you.  
For example:
a. Exceptional hardship, set-back, or personal experience that has shaped your abilities.
b. Personal responsibilities
c. Exceptional achievements or special talents
d. Goals
e. Ways you may be associated with the institution.


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________
Please tell us why you chose to enter this profession and the expectations you have of attending
Lubbock Hair Academy.



_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________
I certify that the information on this application is accurate and complete and subject to verification by
Lubbock Hair Academy.  I authorize such verification and release from liability any person giving or
receiving such information.  I understand that any misrepresentation or omission of facts would be
detrimental to this application and may be cause for preventing my being accepted as a student.  This
application does not constitute a contract of admission.




Signature                                                        Date

_______________________________                 _________________________________