APPLICATION FOR ADMISSIONS

Class Dates 2011-2012 (please check session you would like to attend)

Tuesday, Thursday & Friday 8am-3pm

October 18, 2011-March 23, 2012

Monday, Wednesday & Friday 8am-3pm

February 13, 2012-July 20, 2012

July 30, 2012-January4, 2013

Please print the following:

Personal Information

Name: ______________________ ________________________ ________________________

                          First                           Middle                                      Last

Date of Birth: ________________                           

Home Address: ____________________________________________________      __________

                                       Street                                                                               Apt. #

                       ____________________________________     ________   ________________

                                       City                                                 State                Zip Code

Home Phone:    _____-_____-_______                       _____-_____-_______

                                  Day                                               Evening

Spouse: _________________________                      _____-_____-_______

                         Name                                                     Phone

Emergency Contact: ____________________            _____-_____-_______

                                      Name                                        Phone

Current Employer: _____________________             _____-_____-_______

                               Name of Business                              Phone

Employers Name: ______________________            _____-_____-_______

                                 Name                                             Phone

Personal References

Please list three (3) people to whom you are not related to as character references.

1) _________________________________                             _____-_____-_______

                Name                                                                             Phone

2) _________________________________                             _____-_____-_______

                Name                                                                             Phone

3) _________________________________                             _____-_____-_______

                Name                                                                             Phone

Medical Conditions

For safety reasons, all applicants must disclose any and all medical conditions that you may have. These records will be kept confidential. Only the student, school director and instructors have access to this information.

Please check one of the following:

I am:                          Left Handed  _____                                     Right Handed _____

Education

Please include a photocopy of:

                                                High School Diploma   or   G.E.D

List any education obtained after graduation or completion of a G.E.D

(You may list additional information the back of this page.)

Please list any previous grooming skills and/or pet related occupations.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please briefly explain why the MACC appeals to you.

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are your future aspirations upon graduation?

___________________________________________________________________________________________________________________________________________________________________

To the best of my knowledge, I declare all of the above information to be complete and accurate.

______________________               __________

Signature of applicant                           Date

______________________               __________

Signature of administrator                     Date

Upon consideration of enrollment, the applicant will be required to conduct a brief interview. This can be done at the school  or by phone.

Upon acceptance into enrollment, all fees for registration, tuition, books, and equipment must be paid in full no later than one month (30 days) prior to the first day of class.

This school is licensed by the Massachusetts Department of Elementary & Secondary Education

Office of Proprietary Schools

Any comments, questions or concerns about the school's license should be directed to:

proprietaryschools@doe.mass.edu

located at 75 Pleasant Street Malden Ma 02148-4906

or

781-338-6048

Complaints to the Massachusetts Department of Elementary & Secondary Education  must be made in writing.

Forms are available on their website proprietaryschools@doe.mass.edu

Certificate of Completion

Upon completion of either the Professional Groomer Certification Program students will receive the beautiful Certificate of the Completion shown below. This certificate shows prospective employers and clients that the graduate has demonstrated the knowledge, skills, and professionalism important to a successful career in this rapidly expanding field.