Application for Admission
Empower Academy is excited to have you! We do currently have a waitlist, so in order to secure your place on that list and speed up placement, please fill out this application + submit your registration fee of $400. This is a non refundable payment that goes towards your curriculum kit. You will be notified when your classes are ready to begin. Prior to your start date, please bring a copy of the following legal documents. 1. Drivers License 2. High School diploma 3. Social Security Card 4. Passport photo . Students can not begin classes until these documents have been filed at Empower Academy. We look forward to seeing you!
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
How did you hear about us?
Please Select
Ad
Social Media
A friend referred me
other
Last 4 digits of your social security #
Date of birth
Age
Marital status
Number of students
Education + Training
Highest grade of High School Education
Please Select
9
10
11
12
Highest grade of college completed
Please Select
1
2
3
4
5
6
Name of High School
Year graduated
Are you a U.S. citizen?
What program would you like to attend?
Please Select
Cosmetology
Esthetics
Nail Technician
Dry Stylist
Apprentice
Do you want to attend part time or full time?
Sex
Race
Income
Dependency Status
Head of household
Number of dependents
Miles from school
Demographic area
I understand that this form does not secure my spot on the waitlist. I must pay my registration fee of $400 to be fully registered.
I understand
Signature
Continue
Continue
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