New Online Application Form

Please Note: Returning applicants can't update demographic data, but may enter data in empty fields.

Online Application Form

Personal Information

First Name

Last Name

Street

City

State/Province

Zip/Postcode

Cell Phone

Birth Date

Social Security No

Gender

Program

Campus

Enroll In

Program

Hours Per Week

Class Schedule

Education

Highest level of education completed

Name of High School or GED Testing Center:

High School Graduation Date

Do you have any other schools to list

Yes No Not Selected

Name of School

Emergency Contact Information

Contact Name

Relationship

Cell Phone

Background

Driver License State

Driver License Number

Do you have any other professional licenses?

Yes No Not Selected

The State License Department may require a background and criminal record check prior to a licensing test. Do you have any incidents in your past that may cause concern?

Yes No Not Selected

How did you first hear about the us?

Medical

Do you have any allergies?

Yes No Not Selected

Are you taking any prescribed medication that may affect or impair your ability to participate in the program?

Yes No Not Selected

Do you have a documented learning disability?

Yes No Not Selected

Do you have or have you ever been diagnosed as having any hand, arm, or forearm condition?

Yes No Not Selected

Do you have or have you ever been diagnosed with a lower back condition injury or disorder?

Yes No Not Selected

Do you have or require an IEP

Yes No Not Selected

Do you have any medical, physical, or mental conditions, including but not limited to injuries or disabilities?

Yes No Not Selected

If you checked yes to anything above please describe in complete detail.

Signature

Student First & Last Name

Student Signature

Date

MM/DD/YYYY

Enter the above code

Required

Dolly Monroe Beauty Academy does not discriminate based on race, color, religion, national origin, sex, sexual orientation, gender identity/expression, disability, age, genetic information, economic status, or any other protected characteristic. Our admissions process is designed to select candidates who demonstrate passion, creativity, and commitment to success.