First name*
Last name*
Address*
City*
State*
Zip*
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AL
AK
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AR
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CT
DE
FL
GA
HI
ID
IL
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IA
KS
KY
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ME
MD
MA
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OH
OK
OR
PA
RI
SC
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TN
TX
UT
VT
VA
WA
DC
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Day phone*
Type
- choose one -
Home
Business
Mobile
Fax
Evening phone
Type
- choose one -
Home
Business
Mobile
Fax
Email
Program of interest*
- choose one -
cosmetology full-time
cosmetology part-time
Campus of interest*
- choose campus -
Akron, OH
Arlington, TX
Aurora-Naperville, IL
Austin, TX
Avon, IN
Baltimore-Golden Ring, MD
Blaine, MN
Burnsville, MN
Canton, OH
Castleton, IN
Champaign, IL
Charlotte, NC
Chattanooga, TN
Cleveland, OH
Columbia, SC
Columbus, OH
Copperwood, TX
Crystal Lake, IL
Cypresswood, TX
Darien-Downers Grove, IL
Dayton, OH
Detroit-Lakeside, MI
Detroit-Southgate, MI
Duluth, MN
Durham, NC
East Tucson, AZ
Eastgate, OH
El Paso, TX
Elgin, IL
Evansville, IN
Fairview Heights, IL
Fayetteville, AR
Flint, MI
Fort Myers, FL
Ft. Collins, CO
Grand Rapids, MI
Greenfield, WI
Greenwood, IN
Independence, MO
Jacksonville-Orange Park, FL
Jacksonville-Regency, FL
Joliet, IL
Knoxville, TN
Lakewood, CO
Lansing, MI
Little Rock, AR
Madison, WI
Manassas, VA
Maplewood, MN
Mehlville, MO
Merrillville, IN
Mesa, AZ
Mesquite, TX
Metro Center, AZ
Nashville, TN
North Nashville, TN
North Olmsted, OH
North Tucson, AZ
Olathe, KS
Pasadena, TX
Peoria, IL
Ridgedale, MN
Roanoke, VA
Rockford, IL
Round Rock, TX
Shreveport, LA
South Bend, IN
Spartanburg, SC
Springfield, MO
St Cloud, MN
St Peters, MO
SW Houston, TX
Tinley Park, IL
Toledo, OH
Tolleson, AZ
Topeka, KS
Tri-County, OH
Westminster, CO
Wichita, KS
Winston-Salem, NC
When are you looking to start school?*
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Immediately
1-3 months
6-12 months
More than twelve months
How did you hear about us?*
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bus ad
college fair
high school
drive by
employment guide
internet search
other
phone book
received mailer
radio
referral
billboard
newspaper ad
newspaper article
magazine ad
Highest level of education
- choose one -
Current HS senior/grade 12
High school junior or below
High school diploma/GED
College or university 1+ years
College or university graduate
Year of HS graduation / GED
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