Renasci Academy of Hair, Inc...
3 Isaac Street
Norwalk, CT 06850
Tel:(203) 838-0753
 Application For Enrollment Form
Licensed in the state of Connecticut - To determine whether you can gain from our course of study, we ask that you answer questions on this form.  Please answer as fully as you can.  All information will be held in strict confidence and will be used only to determine your aptitude for a career in cosmetology, and upon graduation, for placement - we admit students without regard to race, religion, color creed, sex, age, financial status, military status or national origin.
GENERAL INFORMATION                            APPLICATION $25.00                             DEPOSIT $1125.00
 
First Name: Middle:  Last Name:
Address:   City: State: Zip:
Home Phone:   Cell:   Work:
E-Mail:
Social Security Number:   Marital Status:
Birth Date:   Age:   Sex:
 
In case of emergency, notify: 
EDUCATION
High School Graduate: Yes     No                                            If ( yes ) Year:
How long have you had an interest in cosmetology?
Why do you wish to enter this career field?
What other careers have you considered?
When would you begin training?
In which state do you plan to take your boards?
Do you need part time work while in school?  Yes     No
Do you have transportation?  Yes     No
Do you desire employment immediately after graduation?  Yes   No  Part time   Full time
How did you hear about Renasci Academy of Hair? 
Who ( If anyone ) reffered you?