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Central State Online Enrollment
Thank you for completing this form. This entitles you to a tour of our school, a free catalog and you will be placed on our mailing list to receive Central State Beauty / Massage Academy specials.
First Name:
Last Name:
Address:
City:
State:
Zip:
Phone:
Date of Birth (mm/dd/yy):
Email:
I am interested in the following (select at least 1):
Cosmetology
Cometology Instructor
Day Classes
Esthetician
Nails
Night Classes
Massage
How did you hear about Central State Academy?
Have you attended any school beyond the High School Level?
Yes
No
If yes, where (Name of insitution and address)?
When (mm/dd/yy)? From:
To:
How will you be paying for your education?
Do you have a GED or High School Diploma?
Last grade completed:
Yes
No
High School Attended:
Date Graduated (mm/dd/yy):
Questions / Comments?
Call us or come in today to see how much you qualify for!! (405-722-4499
)
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