Personal Information
-Name:		TX Drivers Lic./ ID#
Social Security #:		DOB: Age:
Address: Apt. #
City: State: Zip:
Telephone - Home:		Work:
Pager:		Emergency:

Program Status:
COURSE OF STUDY -

1 COSMETOLOGY	.........1500 HRS	TRANSFER HRS
2 NAIL TECHNICIAN	.........600 HRS
3 FACIALIST	.........750 HRS
4 SHAMPOO TECHNICIAN	.........150 HRS
5 INSTRUCTOR TRAINING	.........750 HRS	( ) 250 HRS W/2 YRS EXP.

FULL TIME
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DAY
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PART TIME
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EVENING
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LENGTH OF COURSE:
HRS OF EDUCATION:

SCHOOL TERM TO BEGIN:

TERM TO END:

_________DO NOT WRITE BELOW THIS LINE_________________

THIS COURSE OF STUDY IS INTENDED TO QUALIFY STUDENTS FOR THE STATE LICENSING EXAMINATION. IF ADDITIONAL INSTRUCTION IS NEEDED PAST THE STATED CONTACT TIME. WHICH INCLUDES A GRACE PERIOD OF_________ DAYS, INSTRUCTION WIL BE PROVIDED AT A RATE OF $__________ PER HOUR. UPON COMPLETION OF THE CONTRACTED PROGRAM. THE STUDENT WILL BE AWARDED A DIPLOMA.

REGISTRATION REQUIREMENTS (bring with you to the interview):

At Least 17 years of age.

GED/Diploma or High School Student.

Social Security Card

Driver License Identification Card

$25.00 Money order made out to T.C.C.

2 Passport Photos

FULL TIME	()	DAY	()
PART TIME	()	EVENING	( )

LENGTH OF COURSE:		HRS OF EDUCATION:
SCHOOL TERM TO BEGIN:		TERM TO END:

_________DO NOT WRITE BELOW THIS LINE_________________ THIS COURSE OF STUDY IS INTENDED TO QUALIFY STUDENTS FOR THE STATE LICENSING EXAMINATION. IF ADDITIONAL INSTRUCTION IS NEEDED PAST THE STATED CONTACT TIME. WHICH INCLUDES A GRACE PERIOD OF_________ DAYS, INSTRUCTION WIL BE PROVIDED AT A RATE OF $__________ PER HOUR. UPON COMPLETION OF THE CONTRACTED PROGRAM. THE STUDENT WILL BE AWARDED A DIPLOMA. REGISTRATION REQUIREMENTS (bring with you to the interview): At Least 17 years of age. GED/Diploma or High School Student. Social Security Card Driver License Identification Card $25.00 Money order made out to T.C.C. 2 Passport Photos