MarJon School of Beauty Culture, Ltd.
Enrollment Application

Application Procedure (Please type or print all information)

1. Complete all of this Application for Admission
2. Mail or bring this Application and the registration fee to the school.
3. MarJon School of Beauty requests a copy of your High School diploma, High School Equivalency or GED. Also needed is proof of age
   (birth certificate or driver's license), and your social security card.
4. Transfer students must submit official transcripts from any other beauty schools attended.

NAME: __________________________________________________________________________________________________________________
              Last                                                               First                                          Middle                                                           Maiden Name

HOME ADDRESS:

____________________________________________________________________________________________________________
Number          Street                                                                      City                                                             State                   Zip

COUNTY: __________ TELEPHONE: _______________________________ ______________________________
Home                                                               Work

AGE: _____________ DATE OF BIRTH: _____________________ SOCIAL SECURITY NUMBER _____________________________

EMERGENCY PHONE NUMBER: ________________________ NAME & RELATIONSHIP: ____________________________________

MONTH YOU WISH TO ENTER:

	JAN._____	MAY _____	SEPT ______
	FEB _____	JUNE _____	OCT ______	DAYS	______
YEAR:______	MAR ______	JULY _____	NOV _____
	APR ______	AUG _____	DEC ______	NIGHTS	______

CERTIFICATE PROGRAM:

_________ HAIR DRESSING AND COSMETOLOGY

HAVE YOU TAKEN ANY OTHER COSMETOLOGY COURSES OR ATTENDED ANY OTHER POST SECONDARY INSTITUTION?

YES ________ NO _______

IF YES, PLEASE LIST BELOW

SCHOOL

CITY/STATE

FROM mo/yr

TO Mo/yr

DATE GRADUATED

LIST WORK EXPERIENCE: (most recent first)

EMPLOYER

CITY/STATE

FROM mo/yr

TO mo/yr

TYPE OF WORK

COMPLIANCE DATA*

RACE:
_________ AMERICAN INDIAN _______ ASIAN AMERICAN _______ HISPANIC OR ALASKAN NATIVE OR PACIFIC ISLANDER

_________ BLACK _______ WHITE ______ OTHER ________________

AGE: ________ UNDER 20 _______ 20 - 23________ 24 - 29_______ 30 - 39 _______ 40 AND OVER

INCOME: ________ $0 - $9,999 ________ $10,000 - $19,999_______ $20,000 - $29,999_______ $30,000 AND OVER

MARITAL STATUS: _________ SINGLE ________ MARRIED ________ DIVORCED/WIDOWED

*This information is being collected voluntarily in compliance with Federal law. It is not used in our admission process.

How did you learn about MarJon School of Beauty Culture?

_____ College Fair _____ Teacher ______ MarJon Graduate    _____ College Night _____ Employer ______ MarJon Student

_____ Admissions Rep _____ Newspaper ______ Television/Radio   _____ Guidance Counselor _____ Yellow Pages ______

Internet Search _________ Other __________________________

How do you plan to make tuition payments?*

______ Installment Payments ______ PELL Grant ______ Cash     ______ Higher Education Loan ______ Veteran's Benefits ______ Other

Have you previously received any Federal and/or State Financial Aid? ______________

If yes, what type of Financial Aid have you received?

_____ TAP ______ Stafford (GSL) _____Perkins (NSDL) _____SEOG _____Other ________

Have you ever received a TAP Waiver resulting from NOT meeting the NYS Program Pursuit or Satisfactory Progress requirements? _____ Yes _____ No

Would you like to receive information on Financial Aid? _____ Yes _____ No

APPLICATION STATEMENT

It is my understanding that I will be considered for acceptance as a student at MarJon School of Beauty Culture by the Admissions Committee. I hereby give consent to allow my picture, as taken by or for the school, to be reproduced for publicity or promotional purposed and to list in school promotional material my name, high school attended and name of employer upon graduation from MarJon School of Beauty Culture. I also authorize MarJon School of Beauty Culture to request my high school transcript, and/or to release information to prospective employers in regard to making application for employment.

I agree to abide by the rules and regulations of the School, as defined in the current Academic Catalog. I will pay tuition, fees, and other charges as stated in the current Academic Catalog of MarJon School of Beauty Culture, a copy of which I have received.

I understand and agree that MarJon School of Beauty Culture has the right to make changes in connection with any subject described in its current Academic Catalog including curriculum, course content, class schedule, faculty, training equipment, tuition rates, and fees as it deems appropriate, and I further agree that the School has the right to make such changes without notice to me and at any time, even after I have begun a program of study or course affected by the change. I understand that MarJon School of Beauty Culture does not in any way promise or guarantee employment for its graduates; however, I understand that the School does provide graduates with assistance and cooperation in securing employment

Applicant's Signature: _____________________________________________________________________________________________