Registration Form

Capilo Registration Form :

Full Name

(Required)

Address

City / Town

State

Zip

Phone

(Required)

E-mail Address

(Required)

Date Of Birth

Social Security Number

Drivers Licence #

Course of Interest

Course Start Date

Education:

Yes

High School Name

Graduate?

College Name

Graduate?

Vocational School

Graduate?

GED

43 Bridge Street
Augusta, Maine 04330
1-207-621-9941

Hours:

Monday

9 - 5

Tuesday

9 - 5

Wednesday

9 - 5

Thursday

9 - 5

Friday

9 - 4

Starting Date:

Leaving Date:

Job Title:

Supervisor (Name):

Employer Phone:

EMPLOYMENT BACKGROUND:

1. Name and Address of Present or Last Employer:

Check box if still employed with this employer:

Description of Work:

2. Name and Address of Previous or Last Employer:

Description of Work:

Starting Date:

Leaving Date:

Job Title:

Supervisor (Name):

Employer Phone:

3. What skills or qualities do you currently have that will help you in your training?

4. What is your financial plan for school?

5. Do you plan on working while attending school? Yes No

If so, where? (Check box if same as Present Employer listed above )

References:

6. Please list three references below:

Name Address Phone

Additional Comments :

More Admission Information:

Financial Assistance Registration Form Graduation Requirements Testing

Member of the
American Aestheticians Education Association

Member of the
American Association of Cosmetology Schools