BBI Enrollment Application

Enrollment Application
Full Legal Name

First NameLast Name
Preferred Name
Date Of Birth*

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State
Zip Code
Phone*
Email Address*
example@example.com
*Email will be our primary source of contact for the enrollment process.
- Please provide a valid email that you can easily acess frequently!
- Keep an eye out for confirmation emails to finalize your enrollment.
- Also, check your spam folder if our emails don't show up in your inbox.
Do you consent to us contacting you via text message or email for enrollment and education purposes?

YesNo
Are you a US Citizen?

YesNo
Gender

FemaleMale
Have you ever been convicted of a felony?

YesNo
If yes, please summarize the charges:
Which program are you interested in attending?

Class CA - Hairdressing and Manicuring (Cosmetology - Full Time, Day Program)
Desired Start Date: When would you like to begin the program?*
Enrollment Fee: A non-refundable $125.00 enrollment fee is required to process your enrollment application.

Fee Includes:
- Application fee - $100
- Licensing Fee - $25 required by Missouri State Board of Cosmetology & Barber Examiners to ensure compliance with state regulations.
Total Enrollment Fee: $125 is Payable to Bloom Beauty Institute

You may pay via cash, check, money order OR Venmo.

Pay your Enrollment Fee Now with VENMO: @bloombeautyinstitute

Click the link above to Venmo your Enrollement Fee. ⬆️

*Please include "Enrollment Fee" along with your First and Last Name as a note under "What's this for?" when making your Venmo payment.
I have already paid my non-refundable Enrollment Fee of $125 to Bloom Beauty Institute to begin my enrollment process.*

YesNo
I agree to pay a non-refundable Enrollment Fee of $125 to Bloom Beauty Institute via cash, check, money order, or Venmo to begin my enrollment process within 7 days of completing this Enrollment Application.

Yes, I agree to pay my Enrollment Fee as soon as possible. I am aware that my enrollment process will not begin until this fee is paid.
EDUCATION
Which of the following have you earned?

High School DiplomaGED (General Education Development) CertificationHomeschooling Program Certification
High School Name
High School Location

Street Address Line 2

CityState

Zip Code
Graduation Date

MonthDayYear
Date
GPA
Level of College Completed:
List any other College/Training attended after High School:
College/School Name
College/School Location

Street Address

Street Address Line 2

CityState

Zip Code
Graduation Date

MonthDayYear
Date
GPA
EMPLOYMENT
Current Employment Status

Employed full-timeEmployed part-timeSelf employedUnemployedFreelancer/ContractorStudentRetiredHomemakerMilitaryInternVolunteerLooking for workOther
Company/Employer
Job Title
Phone
Company/Employer Email
example@example.com
Company/Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Date

MonthDayYear
Date
Currently Employed Here

YesNo
End Date

MonthDayYear
Date
Any Additional Employment History you would like to share?

YesNo
EMPLOYMENT HISTORY
Company/Employer
Job Title
Phone
Company/Employer Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip Code
Start Date

MonthDayYear
Date
Are you currently employed here?

YesNo
End Date

MonthDayYear
Date
PERSONAL REFERENCE
Name
Reference 1
Relationship
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone
PERSONAL REFERENCE #2
Name
Reference 2
Relationship
Address

Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone
EMERGENCY CONTACT
Name
Contact 1
Relationship
Address

Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone
EMERGENCY CONTACT #2
Name
Contact 2
Relationship
Address

Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Phone
MEDICAL INFORMATION
Please list any Allergies, Medical Conditions, etc.
Will any medical conditions affect your training? (If so, how)
HOW DID YOU HEAR ABOUT US?
How did you hear about us?

GoogleWebsiteFlyer/BrochureBusiness CardEmailCareer FairFriend/FamilyEducator/StaffAt an EventFacebookTikTokInstagramSnapchatOther
Please Specify: who told you about us/what event did you learn about us at?
Important Enrollment Information
PLEASE NOTE: In addition to submitting this enrollment application, all applicants MUST Apply for Cosmetology Student License online through Missouri Division of Professional Registration to finalize enrollment.

*We will email you step-by-step instructions to help you complete this step after you submit this application*

For this process, students must:
- Upload proof of Education: High School Diploma, homeschooling certificate, GED or transcript
- Upload Proof of Citizenship – Birth Certificate, Passport, or Naturalization.
- Upload two digital headshot style photos of yourself (2”x2” passport photos)
Do you agree to complete the steps listed above to finalize your enrollment? *Enrollment will not be finalized until you submit the above info to the Missouri Division of Professional Registration and get your student license approved.*

Yes, I have read the information above. I understand that I my next step after I submit this Enrollment Application will be to submit my Student License Application to Missouri Division of Professional Regulation (MoPRO).
IMPORTANT PROGRAM DETAILS:
- A minimum of 1,500 hours of training in a licensed school are required for completion of a Cosmetology Class CA program in the state of Missouri to be eligible to sit for exams administered by the Missouri State Board of Cosmetology and Barber Examiners.
- Our Cosmetology program takes about 43-45 weeks (or 11 months) to complete.
- Class Schedule: Full-time, day program
  Mon - Thur . . . . . 8:30am - 4:30pm
  Friday . . . . . . . . . 8:30am - 3:00pm
  *Students get a 30 minute lunch break each day.
- Total tuition for our program is $16,800 including a deluxe cosmetology kit, manicuring kit, makeup kit, textbook and student iPad.
- Bloom Beauty Institute does not currently offer financial aid. (We are in the process of obtaining resources to offer financial assistance, private loans and federal aid.)
- Payment options include: In-house interest free payment plan, Pay-in-full (with $250 pay-in-full discount), or you may obtain a personal loan through a lender of your choice.
- Bloom Beauty Institute is not eligible to offer a 1098-T form. As a result, tuition will not qualify for tax deductions or education credits.
I have read all important info and program details. I understand and agree to all of the above terms and conditions. I would like to proceed with enrollment.*

Yes, I understand and agree to all the above terms and conditions.
Applicant Signature*

Clear
Todays Date*

MonthDayYear
Date
Should be Empty:

Enrollment Application

EDUCATION

EMPLOYMENT

EMPLOYMENT HISTORY

PERSONAL REFERENCE

PERSONAL REFERENCE #2

EMERGENCY CONTACT

EMERGENCY CONTACT #2

MEDICAL INFORMATION

HOW DID YOU HEAR ABOUT US?

Important Enrollment Information