Enroll TodayWe're excited that you want to be part of BK Cosmo. We’ll need some information from you to get started. Who are you? Name * First Name Last Name Email * Date of Birth * MM DD YYYY Age * Social Security Number * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Driver's License Number * Are you a U.S. Citizen? * Yes No If you are not a citizen, what is your Visa type and endorsement? Please select your race. * White Black or African American Asian American Indian Alaka Native Native Hawaiian or Pacific Islander Hispanic/Latino Other If race is 'Other,' please type race here. Education Have you completed high school? * Must provide documentation to prove completion. Yes No Have you obtained your GED? * Must provide documentation to prove completion. Yes No I have a high school diploma Health Information Do you have allergies? * No Yes If you have allergies, please explain what they are. If you have allergies, please list medications. Other Education Have you previously attended or will be attending another college, business school, trade school, technical school or cosmetology school prior to or during your attendance at BK Cosmo? * No Yes If yes, please complete the following: Name of School When did you start attending this school? MM DD YYYY When did you stop attending this school? MM DD YYYY Address of School Address 1 Address 2 City State/Province Zip/Postal Code Country What programs were you enrolled in? Were you granted a degree? No Yes Did you receive financial aid? No Yes Additional Information Marital Status * Single Married Divorced Widowed Separated Date of last Marital Status change. * MM DD YYYY Number of Dependents? * If 0, type 0. Parents Marital Status * Single Married Divorced Widowed Separated Date of last Marital Status change for Parents * MM DD YYYY If you have any U.S. Military affiliation, please check all that apply. * Current or former service member Dependent of a current or former service member I intend to use my GI Bill benefit I do not have an affiliation with the U.S. Military Employment Do you plan on continuing working during your attendance at school? * Yes No Name of Employer * Address of Employment * Address 1 Address 2 City State/Province Zip/Postal Code Country Employer Phone Number * (###) ### #### Living Situation If renting residence, provide landlord or company information. Landlord name or Company Name Landlord Phone Number References List two reference: (One must be next of kin, not to include spouse.) Reference #1 Name * First Name Last Name Reference #1 Phone * (###) ### #### Relationship to Reference #1 * Address of Reference #1 Address 1 Address 2 City State/Province Zip/Postal Code Country Reference #2 Name * First Name Last Name Reference #2 Phone * (###) ### #### Relationship to Reference #2 * Address of Reference #2 Address 1 Address 2 City State/Province Zip/Postal Code Country If married, provide spouse’s employer information. Name of Spouse's Employer Address of Spouse's Employer Address 1 Address 2 City State/Province Zip/Postal Code Country Phone of Spouse's Employer (###) ### #### Length of employment for Spouse's employer. Example: May 1, 2020 - February 1, 2021 In Conclusion Please tell us why you are applying to BK Cosmo. Thank you! * Signature * Please type your first and last name to act as a signature for this form. First Name Last Name Today's Date * MM DD YYYY Thank you!
