WISCONSIN COLLEGE OF COSMETOLOGY, INC

INFORMATION REQUEST

Signature____________________________________Date__________________________

_____________________________________________________________________________________

Last First Middle Maiden

Address Ctiy State Zipcode

Telephone_____________________________ Cel Phone_________________________ .

E Mail_______________________________________________ Social Security_______________________________________

Male _____ Female ______ Age__________ Birthdate_________________________

High School______________________________________________Graduation year_________________ Diploma/GED (circle)

1) Have you attended a previous college or technical college prior to today? No Yes Name_______________________

2) How were you referred to Wisconsin College of Cosmetology?

_____Guidance Counselor _____Friend/Relative _____TV _____Radio ____Yellow Pages ____Newspaper ____Internet _____Personal Investigation _____Other _____Student Referral _____Customer referral _____WEF

3) Are there any extenuating circumstances that could prevent you from meeting Wisconsin College of Cosmetology schedules, policies, standards and practices?________No _______Yes Why?_____________________________________

4) Preferred Start Date at Wisconsin College of Cosmetology____________________________________________________

Mother Name_________________________________________________ Home number_______________________________

Father Name__________________________________________________ Home number_______________________________

Home Address (parent)_______________________________________________________________________________________

Mother’s Employer_____________________________________________ Work number________________________________

Father’s Employer______________________________________________ Work number________________________________

Spouse’s Name_________________________________________________ Home number_______________________________

Spouse’s Employer______________________________________________ Work Number_______________________________

Employment History

Business Name/Address Years Employed Telephone # Contact Name

1)__________________________________________________________________________________________________________

2)__________________________________________________________________________________________________________

3)__________________________________________________________________________________________________________

References: (personal)

1)__________________________________________________________________________________________________________

2)__________________________________________________________________________________________________________

3)__________________________________________________________________________________________________________

Please Return To WCC with a copy of your Official Transcripts

CONSUMER INFORMATION PROVIDED WITH YOUR TOUR

*Scholarship information *Campus Security Information

*Industry Profile *Contract

*Catalog and insert

WISCONSIN COLLEGE OF COSMETOLOGY, INC

INFORMATION REQUEST

Please mail information to:

Wisconsin College of Cosmetology, Inc

Attn: Admissions

2960 Allied Street

Green Bay, WI 54304

If you have any questions please call 920-336-8888 and ask for the admissions office.

Thank you for your interest in Wisconsin College of Cosmetology.

CLICK HERE TO RETURN TO WEBSITE

www.wccgb.edu