Springfield Beauty Academy Enrollment Form
4223 Annandale Rd. Annandale, VA 22003 | Tel: 703-256-5662 | Email: makebeautyhere@gmail.com

By answering the questions in the form below, I hereby apply for the cosmetology course, which will be taught in English, and in consideration of my enrollment, and your furnishing instruction at Springfield Beauty Academy (SBA), provide the following information and agree to the following payments and conditions. Please see our non-discrimination disclosure and other policies on our website: www.springfieldbeautyacademy.com

Name:
Your answer
Address:
Your answer
Phone number:
Your answer
Social security:
Your answer
Date of birth:
Your answer
Email:
Your answer
Citizenship:
Required
Emergency Contact Name, Relationship, and Phone Number:
Your answer
Indicate your type of enrollment
Transfer hours if any and name of previous school if different from SBA:
Your answer
The program will be taught for 1500 hours over 46 weeks. From Tuesday to Saturday 9:00AM - 4:30PM with 30 minute lunch for 7 hours a day. The following date is when I intend to begin classes. I will also make monthly payments on the 1st of each month.
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Schedule:
Tuesday - Saturday 9:00AM - 4:30PM. 30 minute lunch for 7 hours a day.
Please indicate your intended time of study
Tuition and Fees
Total Tuition Cost: $8740

Cost per hour for transfer or returning SBA students: $5

Down payment and kits are non-refundable and non returnable. All first time students are required to pay $2000 down payment. Returning SBA students do not need to pay application fees or kit fees. Hours needed for graduation will be assessed for transfer students and returning SBA students, and monthly payments of $600 or $300 will be assigned depending on full time, part time, or drop in status. Students are required to make monthly payments regardless of absence, holidays or hours of attendance. If any price modifications have been made, see the payment sheet attached to the printout of this form/contract.

Grace period for monthly payments: 5 days
Penalty fee for late payments: $65
Penalty fee for bounced check: $30 - $40 or a percentage of the check amount

Select a payment option below:
SBA graduation requirements:
1. Satisfactorily complete the state approved 1500-hour program.
2. Satisfactorily complete all required all live model practical performances.
3. Pass the final written examination with at least 75% score.
4. Maintain satisfactory academic progress in theory and practical phases.
5. Fulfill all contractual and financial obligations.
6. If a student completes hours before payments are complete, they will not take final examination nor receive their diploma.
7. Students can only take classes if they are in good standing and have made required monthly payments.
Early Withdrawal
If a student decides to withdraw from the school, a student has to provide notification of intent to withdraw in writing. If Springfield Beauty Academy doesn’t receive student’s withdrawal notification in writing, payments have to be paid on the same date of each month regardless of absence or holidays.
Transfer hours will be granted based on payments made. During a withdrawal process for first time students or returning students, 1 hour equals $5.83, regardless of what discounts were provided at the time the contract was signed. If a student has exceeded hours but not paid for those hours, only hours that are paid will be granted. All completed hours that are paid, will be granted for transfer.
General licensing requirements
1. Receive a diploma from an approved school of Cosmetology.
2. File an application to take the state examination 30 days prior to the examination date.
3. Pay licensing examination fee.
4. Pass the Virginia State Board Examination, which consists of both written and practical demonstrations with a grade of 75% or higher.
Contract acceptance
Note: This contract is not valid until payment is initiated and a copy of a government issued ID is provided to the office on or before the start of class. Students must also provide a copy of your high school or GED diploma, if available, to the office on or before the start of class. Upon submitting this document you will be sent a pay request for you to pay online with a credit card. Please indicate in the comments section below if you'd like to pay in person with cash or check.
My signature below signifies that I have read and understand all aspects of this agreement and do recognize my legal responsibilities in regard to this contract. Type your name here. You will also sign this document in person on or before the first day of class.
Your answer
Date of Signature:
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Please write any comments or concerns here, regarding payments or anything you feel the Academy should know about your enrollment:
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The following is to be filled by SBA, leave this area blank:
Signature of SBA official:
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