OLD-FORM BSP Application

Application for Admission
Enrollment Status*
Start Date (1st preference):*
Choose Location*
Do you have a High School Diploma or Equivalent? (GED)*
Name of school or institution you obtained your diploma or GED? blanks (Please include city and state).
Do you have an active PA Cosmetology License?*
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Last 4 digits of SS#*
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile*

Area CodePhone Number
E-mail*
Gender*

MaleFemale
Are you an US Citizen?*

YesNo
Are you an US Veteran?*

YesNo
How did you hear about us?*
Employment Information
Are you currently employed?*

YesNo
If so, name of employer*
Job Title
Employer phone number*
If not currently working, why?
May we contact your employer for a reference?*

YesNoN/A
Transportation/Childcare
Do you have reliable transportation?*

YesNo
Type of transportation:*
Do you have children?*

YesNo
If yes, do you have reliable childcare?

YesNo
Academic Information
Post-Secondary Degree or Certificates Earned*

Associate'sBachelor'sMaster'sSome College No Degree/CertNone
Previous School Name
Year (TO)

MonthDayYear
Year (FROM)

MonthDayYear
Background Information
For certain crimes the state may deny you licensure, We ask for your history to help determine if you may be denied. We believe in second chances, but do not want to set anyone up for failure. Have you ever been convicted of a felony?*

YesNo
If yes, explain:
Do you have any pending criminal charges (awaiting court hearing), felony charges?*

YesNo
If yes, explain:
Are you on probation or parole?*

YesNo
If yes, explain:
Reference #1 Name*
Relationship*
Phone #*
Reference #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have any medical issues that will prevent you from attending school or being a successful barber?*

YesNo
If yes, explain:
Are you currently in default or have you ever defaulted on a federal student loan?*

YesNo
How is your credit score?*

GoodPoorNo credit established
Please tell us why we should consider you for admission into the barber program? *
I authorize investigations of all statements contained in this application for admission as may be necessary to arriving at a decision.*

YesNo
In the event of enrollment, I understand that false or misleading information given in my application or in the admissions process may result in discharge.*

YesNo
By checking the box below, I agree that the electronic signature submitted on this application is my legally binding signature and attest that all information on this application is true and accurate in content to the best of my knowledge.*

I agree
Signature (please type first and last for electronic submission)*
Date*

MonthDayYear
Financial Aid
Students interested in Financial Aid must complete the Free Application for Federal Student Aid (FAFSA) at https://studentaid.gov/h/apply-for-aid/fafsa
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Application for Admission

Employment Information

Transportation/Childcare

Academic Information

Background Information

Financial Aid