David-Curtis
School of Floral Design |
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Registration Number 87-08-1108T |
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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 |
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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:( ) |
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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." |
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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?
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| 2. What do you hope to accomplish after graduating from our
course?
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Add the following amounts. You may use a calculator:
Twenty-five dollars, plus six dollars, plus one dollar and sixty-three cents?
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Multiply one dollar and twenty cents by the number four. What is the answer?
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Divide thirty-five dollars by the number four. What is the answer?
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What is fifteen percent of seventy-five dollars?
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| Do you have any health conditions or physical limitations
which would prevent you from successfully completing the course? ( )Yes ( )No If Yes, please explain:
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| 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_____________________ |
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Office use only |
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Enrollment Application and Registration Fee received by_____________________________ |
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Paid by: Check_____ Credit Card______ Money Order _____ Other__________ |
| Credit Card Number Exp. Date |
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Paid: Registration $____________ Tuition$__________________________ |
| Accepted into program? Yes______ No______ |
| Non-Acceptance Reason Code (if applicable) Code No.______ |
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Notification of Acceptance sent on _________________________ |
by (School Official)_____________________________ |