Avi Student Policy

AVI Career  Training

Application Request For Admission

Student's Photo
Program(s) of Interest *
Start Date *
Name *
Date of Birth
Address
Age
City
State
Zip
Home Phone
Work Phone:
Cell Phone *
E-Mail ID *
How did you hear about us
 
 
 
 
 
 
 
 
 

The collection and reporting ofracial/ethnic data are mandatory for all institutions that receive, are applicants for, or expect to be applicants for Federal financial assistance as defined in the Department of Education (ED) regulations implementing Title VI of the Civil Rights Act of 1964 (34 CFR 100.13), or defined in any ED regulations implementing Title IX of the Education Amendments of 1972. The collection of racial/ethnic data in vocational programs is mandated by Section 421(a)(1) of the Carl D. Perkins Vocational Education Act.

Veteran
 
 
 
 
 

Do you currently hold or have you been previously licensed in Virginia as an Esthetician, Master Esthetician, Instructor, Massage Therapist, Nail Tech, Wax Tech, Barber or Permanent Tattooist?    yes    No 

If yes, provide the license number and expiration date - Type of VA License
VA License number
Expiration Date
Do you hold a current or expired license, certification or registration in any state or jurisdiction within the United States or its territories (excluding Virginia)?
yes No
Do you have a High School Diploma or GED?*
Last Grade Completed
Spouse Name
Phone Number
Last Place of Employment
Manager Phone
Provide the following information on a relative other than your spouse
Name
Phone
Relationship
How do you plan to pay for this course?
Signature *
Tap to sign here

Date

REFERRALS:

Do you know of anyone (i.e. friends, family or co-workers) that can benefit from our program and change their lives as well? Please list three referrals with their phone numbers and receive a complimentary massage or facial once the referral has started classes.

1.Name
Number
2. Name
Number