David-Curtis School of Floral Design
209 N. Main Street
     Centerville, OH 45459
     Phone: 937-433-0566
1-800-437-7894 FAX:(937) 433-2975

Registration Number 87-08-1108T   

Program: Floral Design and Flower Shop Operation

Please print directly from your browser. Please fill out in full and mail application page only to the above address. Please be sure to click the refund link at the left before filling out your application and mailing it to us. Your enrollment is only complete when the application form and registration fee have been received, processed and you have received your acceptance letter into the program from the school. You may also enroll online

Name: Last                                          First                                       Middle

Address: Number                                 Street

City                                                     State                                       Zip code

Telephone: (      )                                   Email:
Class Date Wish To Attend: Month:                                    Year:
Age:                            Date of Birth:

Social Security Number or State Drivers License Number:

Is this your first degree? (     ) Yes     (     ) No

Sex: (Circle One)    Male            Female

The following information is requested by the State Board of Career Colleges and Schools and the United States Department of Education. Please check one:

Ethnic Group: (     )Non Resident Alien (     )Black - Non Hispanic
(     )American Indian and Alaskan (     )Asian and Pacific Islander
(     )Hispanic (     )White - Non Hispanic (     )Other______________________

If connected with a Flower Shop, give name, address and phone number:_______________________________________________________________

Tuition will be paid by: Student___ Parent/Guardian___ Employer___ Govt____
If a person or organization other than student will be responsible for payment of tuition, please fill in name address and signature.

Name:

Address:

City, State, Zip:                                                Telephone:(     )

Signature of person responsible for payments

Signature:__________________________________Date:________________

As required by the State Board of Proprietary School Registration Administrative Rule 3332-1-09, "it is the schools responsibility to determine with reasonable certainty, in advance of the acceptance of a prospective student's enrollment, that the student meets the minimum basic admissions qualifications to successfully assimilate the program they intend to enter."
To comply with this rule, the David-Curtis School of Floral Design requires all students seeking acceptance to the Floral Design and Flower Shop Operation Program, answer the following questions. You may attach additional sheets if needed for your answers.
1. Why would you like to enter the floral industry?

 

 

2. What do you hope to accomplish after graduating from our course?

 

 

Add the following amounts. You may use a calculator

Twenty-five dollars, plus six dollars, plus one dollar and sixty-three cents?

 

Multiply one dollar and twenty cents by the number four. What is the answer?

 

Divide thirty-five dollars by the number four. What is the answer?

 

What is fifteen percent of seventy-five dollars?

 

Do you have any health conditions or physical limitations which would prevent you from successfully completing the course?
(     )Yes     (     )No

If Yes, please explain:

 

 

By signing my name in below, I declare that I have completed all answers by myself to the best of my ability. I also confirm that no other person persuaded my answers in anyway.
Student Signature_____________________________________________

Date_____________________

Office use only

Enrollment Application and Registration Fee received by_____________________________

Paid by: Check_____ Credit Card______ Money Order _____ Other__________

Credit Card Number                                                                Exp. Date

Paid: Registration $____________ Tuition$__________________________

Accepted into program? Yes______   No______
Non-Acceptance Reason Code (if applicable) Code No.______

Notification of Acceptance sent on _________________________

by (School Official)_____________________________

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