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Merrillville Application for Admission

7990 Broadway  -  Merrillville, Indiana 46410  -  (219) 793-9246 or 9267  -  FAX (219) 793-9271

Name:
 Area Code / Phone #:
Mailing Address:
 Cell Phone* #:
City:
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State / Zip Code:
Date of Birth*:
 Sex*:
E-Mail: (Valid email required)
Your Age*:
 Marital Status*:
I would like to be e-mailed Excel Happenings  
U.S. Citizen?

If not, what Country?

*You are not required to give us this information. It is only used for compiling institutional data. It is not a factor in admission decisions.

Name and Permanent Address of: Is this also your permanent address?
Name:
 Mailing Address:
City:
 State / Zip:
Area Code / Phone #:
  

Educational Information:

I plan to enroll in: Preferred Start Date: (refer to schedule)

Educational Background:

Last High School Attended:
 Graduation Date (month/year):
City:
 State:
If you did not graduate:    
Last school year completed: Have you recieved a G.E.D.? (month/year)

Schools Attended after High School:

Name of School: Address: City: State: Zip: Dates Attended:
from to
from to

What hobbies do you enjoy?

Why do you want to join the beauty industry?

Why Excel Academy?

How did you hear about us? Salon Web Search Advertisement Other:

IMPORTANT :

I certify that all of the information that I have provided on this application is complete and accurate to the best of my knowledge and if admitted, I agree to observe all of the rules and regulations of Excel Academies of Cosmetology.

Name (Signature) Date

Click below to e-mail this application to the Merrillville Excel Academy of Cosmetology.

Print a copy for your records before submitting.