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Registration
209 N. Main Street
Centerville, OH 45459
Phone: 937-433-0566
1-800-437-7894 FAX:(937) 433-2975
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Registration Number 87-08-1108T
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Program: Floral Design and Flower Shop
Operation
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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
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Name:
Last ___________________ First _________________ Middle
___________
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Address: Number and
Street ________________________________________________________________
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City
__________________ State __________________ Zip code
_________
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| 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
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| 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______________________
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If connected with a Flower Shop, give name, address and phone number:_______________________________________________________________
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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:
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Address:
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City, State, Zip:
Telephone:( )
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Signature of person responsible for
payments
Signature:__________________________________Date:________________
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| 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.
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| 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__________
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| Credit Card
Number
Exp. Date |
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Paid: Registration $____________ Tuition$__________________________
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| Accepted into program? Yes______ No______ |
| Non-Acceptance Reason Code (if applicable) Code No.______ |
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Notification of Acceptance sent on _________________________
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by (School Official)_____________________________
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