Career Academy of Cosmetology Application

San Joaquin County ROCP does not discriminate on the basis of race, color, national origin, gender or handicap in its educational programs and activities. All vocational opportunities will be offered without regard to race, color, national origin, gender or handicap. Limited English language skills will not be a barrier to admission and participation in vocational education programs.

Student Type	---- Select One ---- High School Student Adult Not Enrolled in High School
Student Name
Address
City
State
Zip Code
Home Phone
Cell Phone
Age
Date of Birth
Email Address
Current High School (if applicable)
Anticipated year of high school graduation
Name of Previous Cosmetology School (if applicable)
Previous Hours (if applicable)
Class Preference (check all that apply) Morning Class 8:00am - 3:30pm Afternoon Class 12:00pm - 7:30pm Evening Class 3:30pm - 7:30pm
Additional Information
How did you hear about our program?	---- Select One ---- Friend Website High School teacher/counselor Open House Flyer Bus Ad Advertisement Banner Newspaper Ad Other