*Please note that this is not an actual enrollment

Please provide the following information:

Name SSN# --  *Not necessarily required
Date of Birth - - Age years    
           
Address        
City State

Zip Code
  (if less than 3 years at this address, please list address for the last 3 years of residence)
Address        
City State

Zip Code
           
Day Phone        
Eve Phone Email
           
  Are you currently employed? (Yes) (No) if yes, please provide the following information
Employer        
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

           
  U.S. Citizen? Yes No    
If not a U.S. citizen, eligible non citizen? Yes No    
  High School Diploma? Yes No    
  If no High School Diploma, G.E.D? Yes No    
  Bachelor's Degree? Yes No    
  Living on your own? Yes No    
  Living with parents/ relatives? Yes No    
  Total people living in households?      
           
  In your own words explain why attending Colourgraphix Technical School would benefit you in the future and would need a Financial assistance.

 
           

 
         

FATHER'S INFORMATION

        
Name SSN# --
Date of Birth - - Age years    
           
Address        
City State

Zip Code
  (if less than 3 years at this address, please list address for the last 3 years of residence)
Address        
City State

Zip Code
           
Day Phone        
Eve Phone Email
           
  Are you currently employed? (Yes) (No) if yes, please provide the following information
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

 

(if less than 5 years at this employer, please list employer for the last 5 years)

  
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

           
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

           
           
Bank  Accounts:  

Housing

 (check one)  
Checking: (Yes) (No)   Rent?  
Saving: (Yes) (No)   Own?  

Total monthly rent/ mortgage? $

 Name of Mortgage Holder(s)
Credit Cards (check all that applies): Visa? Master Card? American Express? Discover?
           

MOTHER'S INFORMATION

        
Name SSN# --
Date of Birth - - Age years    
           
Address        
City State

Zip Code
  (if less than 3 years at this address, please list address for the last 3 years of residence)  
Address        
City State

Zip Code
           
Day Phone        
Eve Phone Email
           
  Are you currently employed? (Yes) (No) if yes, please provide the following information
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

 

(if less than 5 years at this employer, please list employer for the last 5 years)

  
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

           
Employer        
Job Title      
Address Phone  
City State

Zip Code
 

How long ?    Monthly Gross?

           
           
Bank  Accounts:  

Housing

 (check one)  
Checking: (Yes) (No)   Rent?  
Saving: (Yes) (No)   Own?  
Total monthly rent/ mortgage? $

Name of Mortgage Holder(s)

Credit Cards (check all that applies): Visa? Master Card? American Express? Discover?
           

Colourgraphix Technical School.
Copyright © 2006 [Colourgraphix]. All rights reserved.
Revised: 02/16/06