Student Enrollment Application
South Texas Barber Institute
Full Legal Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Last 4 of your Social Security Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What Program are you applying to?
What is your preferred start date?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What is your preferred class schedule? (Check One)
*
Please Select
Day - 9:00am to 3:00pm
Evening - 3:00pm to 9:00pm
Highest Level of Education Completed
Current Employer ( if applicable)
Are you currently employed?
Please Select
Yes
No
Any additional comments or special requests?
Signature
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