Headlines Barber College
enrollment form
Name
First Name
Middle Name
Last Name
Phone Number
E-mail
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Social Security Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I meet the following requirements (check all that apply):
Professional Outlook
Legal citizen in the U.S.
Reliable & prompt
Able to commit to class timeline
Are you 16+ years of age or older?
Yes
No
Have you ever been convicted of a Felony?
Yes
No
Are you currently living in the West Texas Area?
Yes
No
Where are you located?
Please list the neighborhood you reside in.
Do You Own A Car?
Yes
No
Do You Have A Drivers License?
Yes
No
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Program Desired:
Class
Date You Can Start
-
Month
-
Day
Year
Date Picker Icon
Class Interested In (check all that apply):
Day Class
Cross over
Night Class
Other
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Education:
Highest Level of Education:
Please Select
High School
College
Graduate School
High School
Name of High School Attended
Graduated High School?
Please Select
Yes
No
College
Name of College/University Attended
Graduated College?
Please Select
Yes
No
Trade School/Other
Name of Trade/Technical/Other School Attended
Graduated From Trade School?
Please Select
Yes
No
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References:
Please include at least three
Reference One
Reference One Relationship
Reference One Years Acquainted
Reference One Phone
Reference Two
Name of Reference
Reference Two Relationship
Reference Two Years Acquainted
Reference Two Phone
Reference Three
Name of Reference
Reference Three Relationship
Reference Three Years Acquainted
Reference Three Phone
Disclaimer
I certify that my answers are true and complete the best of my knowledge. If this application leads to emrollment, I understand that false or misleading information in my application or interview may result in my disqualification.
Submit
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