Certificate Program Application
* Complete every question. Required fields are marked with *.
* Use the tab key or mouse to move through the fields.
* The form will automatically save when you move on to another tab by pressing the Next button.
* A on the sidebar indicates that all required information has been completed for that page.
* Once you submit your application, you will no longer have access to it.
Mobile Phone Number:
Confirm Email Address:
Date of Birth:
Social Security Number:
African American (Black) - A person having origins in any of the black racial groups of Africa.
American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment.
Asian - A person having origins in any of the original peoples of the Far East, SoutheastAsia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
Native Hawaiian or Pacific Islander - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
What location would you like to attend?
Do you have a high school diploma or have you taken the GED?
Enter the information needed and press the Add button, the information will show up in the table below. If you need to add another entry you may press the Add button again. To update any entry you can do so by clicking on the Update button and once you are finished you can save it by clicking on the Add button. You can also view the entry details if available by pressing the Details button.
State of high school or state where GED was obtained
Name of high school or institution
Have you attended a previous cosmetology school?
Name of cosmetology school
City of cosmetology school
State of cosmetology school
How did you hear about us?
Have you ever been convicted of a felony?
Are you willing to submit to a background check and drug screen?
Have you ever been convicted of a misdemeanor drug charge or charge related to abuse, neglect or exploitation of an adult?
Verify your application is complete
Each tab on the left side of the screen should have a next to it to indicate you have supplied all the required information. You will not be able to submit your application unless EVERY tab has a . You can go back to the page now and complete the required information, or log back in later and retrieve the application using the email and password you created when you started.
Certify your statements
I hereby certify that the above statements are true and correct to the best of my knowledge. I hereby submit this application for admission to Campbellsville University subject to the policies and procedures of the university.