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ROBERTS’ SCHOOL OF COSMETOLOGY 2415 FAIRBURN ROAD, S. W. ATLANTA, GEORGIA 30331 PRINT APPLICATION AND MAIL WITH YOUR APPLICATION FEE APPLICATION FOR ADMISSION Date_________________
1. Name __________________________________________________ Birth Date __________________________ Last First Middle Mo/Day/Year
2. Present Address _____________________________________________________________________________ Street City State Zip Telephone#
3. Previous Address ____________________________________________________________________________ Street City State Zip Telephone#
4. Social Security#: _____ ____ _____ Sex: M F Race: __________
Marital Status: ( ) I am not married ( ) I am married ( ) I am separated # of Children _______
5. Parent(s)/Guardian(s): Father _________________________________ Name
_____________________________________________________________________________________________ Street Address City State Zip Telephone#
Mother _______________________________________________________________________________________ Name Street Address
_____________________________________________________________________________________________ City State Zip Telephone#
6. In case of emergency notify ____________________________________________________________________ Name Address Telephone#
7. Are you 18 years of age or older? Yes ( ) No ( )
8. Are you employed? Yes ( ) No ( ) If so, may we inquire of your present employer? __________
_____________________________________________________________________________________________ Name of Employer/Supervisor Telephone #
9. Please list the name, address and telephone number for former employer(s) beginning with the last one first:
a. ________________________________________________________ From ___________ To___________
b. ________________________________________________________ From ___________ To ___________
c. ________________________________________________________ From ___________ To ___________
Do you have any beauty salon training? Yes ( ) No ( ) If so, what type? __________________________________
10. References: Give the name of three persons not related to you, whom you have known at least one year.
a. Name ______________________________________ Telephone# _____________________________
b. Name ______________________________________ Telephone# _____________________________
c. Name ______________________________________ Telephone# _____________________________ 11. Education: Grammar _________________________________ From/To _______________Did you graduate? Yes( ) No ( )
High School _______________________________ From/To ______________ Did you graduate? Yes( ) No ( )
College ________________________________ From/To ______________ Did you graduate? Yes( ) No ( )
Trade/Business or Correspondence School _________________________________ From/To _______________ Did you graduate? Yes ( ) No ( )
12. What term do you plan to enter? Fall ( ) Winter ( ) Spring ( ) Summer ( ) Class Date __________________
13. Will you be a full-time or part-time student? Full-time ( ) Part-time ( )
14. What is your intended major? ( ) Esthetics ( ) Manicuring ( ) Master Cosmetology
15. Will you apply for financial aid? Yes ( ) No ( )
16. If transferring from another beauty school, list school:
___________________________________ _______________________________________ _________________ Name of School Address Hours Accumulated
17. List names and relatives attending RSC: _________________________________________________________
18. Is there any reason why you may not be able to perform all duties involved with the courses? If yes please explain: ______________________________________________________________________________________
19. List your extra-curricular activities: (Leadership position(s), honors, hobbies and/or interests, etc.)
If you are applying for a student loan or grant and live with your parent(s) or legal guardian(s), please fill in this section:
Parents’ marital status: ( ) Married ( ) Unmarried ( ) Separated ( ) Divorced Number of children living in household under 18 years of age _________ Number of college students ________ Have you ever received any student loan or grant? Yes ( ) No ( )
If your answer is yes, please explain: _____________________________________________________________________________________________
_____________________________________________________________________________________________
If you are married and applying for a student loan or grant please fill in this section:
Number of family members ________ Number of college students _________
Have you received any student loans or grants? Yes ( ) No ( ) If your answer is yes, please explain: _______________________________________________________________
I certify that the above information is correct to the best of my knowledge. I understand that withholding information or giving false information may make me ineligible for admission to RSC.
_______________________________________________ __________________________ Signature of Applicant Date
DO NOT WRITE BELOW THIS LINE
Interviewed by: _______________________________________________ Date ________________________________
Enrolled: ( ) Yes ( ) No Date Reporting ____________________ Deposit amount ___________________
Limitations/Comments: ____________________________________________________________________________________
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