Step 1 of 5 - Student Information0%Student InformationLegal Name* First Last Preferred Name* First Last Sex*MaleFemaleDate of Birth* MM DD YYYYAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Marital Status*SingleMarriedDivorcedWidow/WidowerSeparatedBirth Last Name*Citizenship*USAEthnic Background*American Indian / Alaskan NativeAsian / Pacific IslanderBlack / Non-HispanicWhite / Non-HispanicHispanicOtherSSNPreferred Phone Number* Select All Cell Home WorkCell Phone*Text Message Communication*YesNoHome Phone*Work Phone*Email* Have you ever been arrested for, charged with, or convicted of criminal conduct, a misdemeanor or a felony***may effect licensure/credentialingNoYesAre you seeking financial assistance through any State or Federal Agency?* Workforce Oklahoma Vocational Rehab VA DHS Native American Tribe Other I am not seeking assistance through any agencyCurrent Employer InformationHave you ever been employed?*YesNoAre You Currently Employed?*YesNoEmployer Name*Employer Phone Number*Position*Start Date* Date Format: MM slash DD slash YYYY End Date* Date Format: MM slash DD slash YYYY Educational BackgroundHave you ever been enrolled at Community Care, Clary Sage or Oklahoma Technical College?*YesNoEducation Level*Select Education LevelStill in High SchoolDid not graduateHigh School DiplomaGEDSome CollegeCollegeName Of High School*Graduation Date / Date GED Recieved*Fill month and day to the best of your knowledge - Year is important MM DD YYYYList All other Colleges, Vocational or Technical Schools*Include whether or not you graduated - Write none if this is not applicableGetting to know You1) What career are you interested in today?*UndecidedBarberCosmetologyEstheticianFashion DesignInterior DesignMakeup Artistry | CosmeticianMassage TherapyNail TechnicianMaster Instructor2) How soon would you like to start classes?*ASAP1-2 Months2-6 Months6+ MonthsWhat three questions are you hoping to get answered by your admissions representative?*Where have you seen us?*Click all that apply. Facebook Advertisement Facebook Post Instagram YouTube Google Search Website Advertisement TV Radio Newspaper Billboard Friend Family Airport Advertisement Bus Advertisement High School Career Fair Recruiter/SpeakerThank you for expressing interest in our College! In an effort to get to know you better please answer the following questions. A minimum of 3-5 complete sentences on EACH of the following 4 questions is required in order to be considered for enrollment.1) Where do you see yourself in 3 years? What goals will your education at this college help you achieve?*2) What led you to choose this field and this College?*3) Tell us about your current situation*4) Our goal is to turn every student into a graduate! What challenges might stand in your way of becoming a successful graduate? What can you do to overcome these challenges in order to be successful? (Ex: Transportation, Bus fare, Family, Finances, Educational challenges)*Emergency Contacts2 Emergency Contacts are requiredEmergency Contact 1* First Last RelationPhone*Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact 2* First Last Relation*Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I certify the information is true to the best of my knowledge and belief and I understand that I subject myself to disciplinary action in the event that the application facts are found to be falsifiedSignature*
