Seward County Community College/Area Technical School
Department of Cosmetology
1801 N Kansas Ave ¡ PO Box 1137
Liberal, KS 67905-1137
1-800-373-9951 ¡ 624-1951
620-417-1361
Application for Cosmetology Program
Confidential (please print or type)
Date:_______ /______ /________
Month Day Year
Name: ____________________________________________________________________
Last First MI
Social Security #: _______________________________
Permanent Address: ____________________________________________________________________________________
Street City St Zip
Current Address: _____________________________________________________________________________________
(if different than above) Street City St Zip
Cell Phone # (_____ )_____________________ Home Phone # (______ )_____________________
Date of Birth:_______ /________ /________
Month Day Year
Email Address: _______________________________________________________________________________________
Alternate Contact Information
Name: ______________________________________________________
Last First
Address: ______________________________________________________________________________________________
Street City St Zip
Phone # (________ )______________________
Program Intention Information
Semester course you are applying for:
¨ Fall (August) o Spring (January)
Program you are applying for:
o Cosmetology o Nail Technology o Cosmetology Instructor Course
Education Information
High School Attended:_____________________________________________________________
Year Graduated:___________________ or GED Completion Date:________________________
Have you ever been convicted of a felony? o Yes o No
Checklist
Before submitting, have you:
o returned your college application for admission to the Admissions Office?
o made an appointment with the Student Success Center to take the COMPASS test, or submitted a copy of your ASSET/ACT scores to the cosmetology department?
o made an appointment with Financial Aid? After you meet with Financial Aid, submit the signed financial aid interview form to the cosmetology department.
o enclosed a cover letter? *
o enclosed three letters of recommendation? *
o enclosed a copy of your high school diploma or GED certificate?
Please be advised that after enrollment on the first day of class, a copy of your driver’s license or a valid state photo ID will be required for the application of the cosmetology or nail technology apprentice license.
* The instructor program applicant does not have to submit a cover letter or letters of recommendation, but will need to submit a copy of their current cosmetology or nail technology license.
Selection Process
When all the information has been received, you will be notified by mail if you have been selected to enroll in the cosmetology program within three weeks of the appropriate due date. At that time, you will need to pay a $100 non-refundable deposit to reserve your class space. The $100 deposit will be credited to the students account once the enrollment process is completed.
How did you hear about the Cosmetology Program at Seward County Community College/Area Technical School?
o Newspaper o Counselor
o TV o Website
o Radio o Yellow Pages
o Friend Attended o High School Career Day/Xtreme Challenge
o Cosmetologist Referred o Other____________________________________
Signature
Student Signature: ___________________________________________________________ Date:______________________
NOTICE OF NONDISCRIMINATION
Seward County Community College is committed to a policy of nondiscrimination involving equal access to education and employment to all, regardless of sex, race, age, religion, color, national origin, or disability. The administration further extends its commitment to fulfilling and implementing the federal and state laws and regulations as specified in Title IX and Section 504 of the Rehabilitation Act. For assistance in these areas, contact the Equal Opportunity Compliance Officer, Seward County Community College, 1801 N Kansas, PO Box 1137, Liberal, KS 67905-1137; Phone (620) 624-1951.