New ENROLLMENT APPLICATION

ENROLLMENT APPLICATION

PROGRAM OF INTEREST

Program

When are you interested in starting school?

STUDENT INFORMATION

First Name

Middle Name

Last Name

Birth Date

Street

Address Line 2

City

State

Zip Code

GOVERNMENT IDENTIFICATION

Driver's License Number

Driver's License State

Driver's License Expiration Date

STUDENT CONTACT INFORMATION

By submitting this Online Application you agree to receive text and emails from Lytle's Beauty College.

Cell Phone

ETHNIC GROUP

This information is required for statistical reporting to the US Department of Education

Ethnicity

EDUCATIONAL INFORMATION:

Did you graduate from High School in the United States?

Yes No Not Selected

If “No,” have you taken and passed a GED test?

Yes No Not Selected

If you answered “No” to the above, please contact an Admissions Representative. Click Save and Continue Later button and call 707-545-8490

Check the highest grade completed

10th

11th

12th

High School Name or Equivalent

City/State

Is this your first time attending college?

Yes No Not Selected

If no, list all schools attended beyond high school:

WORK HISTORY

Current or most recent

Employer Name

From Date:

To Date:

Position Held

PERSONAL INFORMATION

Gender

Marital Status

Living Arrangements

Approximately how many miles away from school do you live?

Income Level

Residency Status

If asked, can you provide proof of citizenship or INS permanent residency document status?

Yes No Not Selected

Are you taking any prescribed medication that may affect or impair your ability to participate in the program?

Yes No Not Selected

Are you allergic to anything?

Yes No Not Selected

If yes, please share what you are allergic to.

We would love to follow you on Instagram and Facebook! Feel free to list your social media handle:

Background History

Have you ever been convicted of a criminal offense, felony, or misdemeanor (or entered a plea of nolo contendra) other than a minor traffic violation?

Yes No Not Selected

If yes, briefly explain. If you answered yes, please see an Admissions Representative. An additional application may need to be completed for the Board of Barbering & Cosmetology. The question may determine your eligibility to the the state exam and enroll in school.

FINANCING/FINANCIAL AID

Are you interested in applying for financial aid? (www.fafsa.gov)

Yes No Not Selected

Do you have funds saved for college?

Yes No Not Selected

Have you ever received financial aid?

Yes No Not Selected

If “Yes,” Where and When:

Have you defaulted on a student loan or do you owe a refund of federal funds?

Yes No Not Selected

Has your financial situation changed from the last tax year?

Yes No Not Selected

If “Yes” briefly explain:

Financial aid will not cover the $2,000.00 down payment required. Are you financially prepared to provide the down payment on your class orientation date?

Yes No Not Selected
Note: Financial aid WILL NOT cover the $2,000 down payment required.

REFERENCES

Please include 2 references. Can include family member, close friend, current or previous employer.

Reference # 1 Name

Reference # 1 Relationship

Reference # 1 Address

Reference # 1 Phone Number

Reference # 2 Name

Reference # 2 Address

Reference # 2 Phone Number

Reference # 2 Relationship

Applicant Signature

The information that you provide on this application will be kept confidential, and will help determine your ability to benefit from the program. Your information will be kept on file for 6 months.
If no further contact after 6 months, all files will be purged.

I certify that all information provided on this form is true and correct to the best of my knowledge. I also understand that I may be required to provide supporting documentation of the information reported.
Falsifying information may result in denial of enrollment or expulsion from school.

Today's Date

Applicant Signature

Student Digital Signature

Enter the above code

Required

Lytle’s Redwood Empire Beauty College 186 Wikiup Drive Santa Rosa, CA 95403
Admissions: (707) 545-8490 Email: info@lytlesrebc.edu