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Your enrollment application.

Please fill out the form below as thoroughly as possible. Once received, a Summit representative will be in contact with you to discuss your application. If you have any questions, please feel free to call us at (765) 649-5555.

Basic information

Course of Study *

Cosmetology

Esthetics

Nail Tech

Instructor

Barbering

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone # *

(###)

###

####

Cell Phone # *

(###)

###

####

Can we text you?

Yes

Email Address *

Date of Birth *

YYYY

In Case of Emergency, Please Notify *

Parent Contact #1 *

Spouse Contact & Parent Contact #2 *

Education

High School *

The Academy requires high school graduation or a G.E.D.

City, State *

Year Graduated *

Grade Average

Other School

City, State

Major/Course

Graduation Date

Grade Average

Honors

Additional Training

Use this space for any additional training

Employment History

Employer

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

(###)

###

####

Position

Start Date

YYYY

End Date

YYYY

Salary

Employer

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone #

(###)

###

####

Position

Start Date

YYYY

End Date

YYYY

Salary

Additional Employers

Use this space for any additional employers.

Questions

How did you hear about Summit Salon Academy? *

Why do you want to enter this career? *

Class Starting Date *

Please enter the class (Cosmetology, Esthetics, Nail Tech), and month/year.

Have you ever been convicted of a felony? *

Yes

Citizenship? *

Other

If other citizenship, what country?

Are you a veteran? *

Yes

Please list any and all allergies

Do you have any health issues that could impact your training?

Please explain.

By checking this box, you certify that all statements made in this application are complete and true. When you come in, you will be asked to sign and date the application and provide your social security number.

I certify that all statements made in this application are complete and true.

Thank you!