ALABAMA BOARD OF COSMETOLOGY & BARBERING
RSA Union Building | 100 N. Union Street | Suite 324 | Montgomery, Alabama 36104 PO Box 301750 | Montgomery, Alabama 36130-1750 Phone | 334 242 1918 Toll Free | 1 800 815 7453
STUDENT ENROLLMENT FORM
Please complete this form and provide all requested information and documents. Once your information has been submitted and reviewed, we will send the enrollment form to you for your signature.
STUDENT INFORMATION
Student's Name
First Name
Middle Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Date of Birth (MM/DD/YYYY)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Social Security Number
*
Email address
*
example@example.com
License Number if Currently Held
License Type
Hours Trained in Another School (attach letter from other school)
Type of Enrollment:
*
Barber
Cosmetologist
Esthetician
Instructor
Manicurist
Manicurist/Waxer
SPONSORSHIP/TRANSLATOR
A sponsor/translator is a person who helps you with enrollment, communication, or understanding the school’s information and online forms. This person may also help you enroll in or attend the program. If you do not have a sponsor or translator, you may then go to the Upload Documents section.
Do you have a Sponsor or Translator?
Yes
No
If YES, what is your Sponsor's Name?
First Name
Middle Name
Last Name
Sponsor's Email
example@example.com
Sponsor's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you want all communications to go to Sponsor ONLY or Student ONLY?
Send emails/phone calls to Sponsor ONLY
Send emails/phone calls to Student ONLY
UPLOAD DOCUMENTS
Driver's License - Upload File
Browse Files
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Choose a file
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Social Security Card - Upload File
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ABOC Professional License - Upload File
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Permanent Resident Card - Upload File
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If you are transferring hours over from another school, Upload Transcript Here
Browse Files
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of
CERTIFICATION
Certification
*
I certify that I am either a citizen of the United States or legally present in the United States and authorized to work.
REVISED 1/2020
Submit
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