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APPLICATION

There is a $100 application fee. Please fill out application on a desktop.

Apply Here

First name

Last name

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

PARENT/GUARDIAN (IF APPLICANT IS UNDER 21)

First Name

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

SPOUSE OR PERMANENT CONTACT

First

Spouse?

Yes

No

Last Name

Phone Number

PERSONAL INFORMATION ENROLLMENT

Social Security Number

Ethnicity

Hispanic

Non-Hispanic

Birthday

Race (if Non-Hispanic)

PREVIOUS COSMETOLOGY

Please list all prior programs which you have attended.

CITIZENSHIP

Are you a United States citizen?

Yes

No

If no, enter the country of your citizenship

DISCLOSURE

Have you ever been convicted of possession or distribution of a controlled substance?

Yes

No

Have you been convicted of a felony?

Yes

No

If yes, please explain.

HIGH SCHOOL INFORMATION

High School Attended

High School GPA

High School Graduation Date

Do you have a GED?

Yes

No

I hereby give permission for Divinity to obtain any necessary transcripts from prior educational institutions.

Yes

No

SIGNATURE

By entering your name and date below, you certify that the information herein is factually accurate and completed. Please print your full name.

Your Signature

Today's Date

Thanks for applying!We'll get back to you soon.

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3207 E. Indian Trail
Louisville, KY 40213

Tel:502-501-4042

info@divinitysoc.org

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