• Have you ever been convicted of a criminal offense? [ ]Yes [ ] No
  (If yes, provide details on charges, locations, dates and dispositions. If additional space is needed, please attach a separate sheet.) ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
  
• Are there any criminal charges pending against you at this time? [ ] Yes [ ] No
  (If yes, provide details on charges, locations, and dates. If additional space is needed, please attach a separate sheet.) ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
  
• Have you ever been expelled, suspended or placed on probation from any school or college for any reason?
  [ ] Yes [ ] No
  (If yes, please provide details or circumstances. If additional space is needed, please attach a separate sheet.) ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
  
• have you ever applied to or been enrolled in the Dudley Beauty School System, Inc.? [ ] Yes [ ] No
  (If yes, give the campus location and dates of attendance. If you did not complete the course, please explain why. If additional space
  is needed, please attach a separate sheet.) ____________________________________________________________________________________________________ ____________________________________________________________________________________________________
  
• Have you ever attended another cosmetology school? [ ] Yes [ ] No
  If yes, please provide the following information on your previous cosmetology school(s):
  

  Name____________________________________	Name____________________________________
  Address__________________________________	Address__________________________________
  City__________________ State___ Zip________	City__________________ State___ Zip________
  Telephone Number _____/_____/________	Telephone Number _____/_____/________
  Dates of Attendance_______________________	Dates of Attendance_______________________

Explain why you did not complete their program. If additional space is needed, please attach a separate sheet.
____________________________________________________________________________________________________ ____________________________________________________________________________________________________
____________________________________________________________________________________________________

Please share with us your interests, hobbies, sports, special training and skills that would contribute to your education with the Dudley Beauty School System, Inc.
____________________________________________________________________________________________________ ____________________________________________________________________________________________________
____________________________________________________________________________________________________

In a minimum of 200 words (but not exceeding 300 words), write an essay describing your purpose and goal for pursuing an education in cosmetology and what influence you expect the Dudley Beauty School System, Inc. to have on your life. Put your name, address and phone number on the page and the heading "STATEMENT OF PURPOSE." Your STATEMENT OF PURPOSE must be typed or printed and submitted with your application packet.

I certify that the information I have given on this application is complete and accurate. any willful misrepresentation of fact may be cause for withdrawal of my application from consideration, cancellation of admission or registration or suspension form the school.

I heareby acknowledge that the institution may verify the informatin set forth herein from sources accessible under law to the institution but that the institution may divulge the contents of this applicaiton only as permitted under the Family Educational Rights and Privacy Act of 1974 if I am or have been in attendance at this institution. Further, I authorize the Dudley Beauty School System, Inc. to do a criminal background check.

Signature of Applicant:__________________________________________ Date:______________

If under 18, signature of parent or guardian:_____________________________ Date:______________