Name *

First Name

Last Name

Phone *

Please provide a phone number that we can contact you at.

(###)

###

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Program *

Cosmetology

Esthetics

Manicuring

Natural Hair

Today's Date *

MM

DD

YYYY

Special Circumstance *

Please check any that apply and email appropriate documentation to the school.

Deceased

Disabled

Enrolled in Related Program

Transferred

Deployed

Incarcerated

Early Withdrawal (Within 30 days of Program Start Date))

Don't Know

None of the Above

Acknowledgement *

I acknowledge that Creative Hair School of Cosmetology will call me within 3-5 business days to confirm prior to processing any withdrawal request.

Yes

No