William Edge Institute — Admissions Application

Personal Information

First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Permanent Address (if different)

Home Phone

Cell Phone *

Social Security Number *

E-mail Address *

Driver's License #

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U.S. Citizen

Emergency Contact Name (first and last) *

Emergency Contact Phone *

Edge-ucation Plans

Program Interested In *

Start Date *

Have you ever attended a cosmetology school before? *

If yes, where and when

Educational Background

List the last high school you attended and your status when you left (i.e. Grad, GED)

High School *

City/State *

Grad or GED Date *

College (leave blank if none)

College City/State (leave blank if none)

College Grad Date (leave blank if none)

Technical School (leave blank if none)

Technical School City/State (leave blank if none)

Technical School Grad Date (leave blank if none)

Have you ever been suspended or dismissed from any school for academic, attendance or disciplinary reasons? *

If yes, explain

To provide you the best education, please let us know if you have an IEP or Special Education plan so we can make accommodations. *

If yes, explain

Application Consideration

Please explain why you feel you should be considered for acceptance to the William Edge Institute. *

Request for Confidential Information

It may be used in reporting under federal and state law and regulations. It will not be used as a basis for admissions or in any discriminatory manner.

Date of Birth *

Gender

Predominant Ethnic Background

Residency

Age Group

Highest level of education completed

Family Income

Student Certification

I certify that to the best of my knowledge, the information given in this application is true. I understand that any misrepresentation of information is sufficient grounds for refusal of admissions to the William Edge Institute. I further understand that, if I am approved into the program, it is MY RESPONSIBILITY to provide ALL admissions documents at the time of my enrollment.

The William Edge Institute is committed to the policy that all students should have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national or ethnic origin, sex, age, marital status, disability, or sexual orientation.

Applicant's Signature *

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Date Signed *

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