Central State Online Enrollment Application


Thank you for completing this form. This entitles you to a tour of our school, a free catalog and you will be placed on our mailing list to receive Central State Beauty / Massage Academy specials.
First Name: Last Name:
Address:
City: State: Zip:
Phone: Date of Birth (mm/dd/yy): Email:
I am interested in the following (select at least 1):


How did you hear about Central State Academy?
Have you attended any school beyond the High School Level?
If yes, where (Name of insitution and address)?
When (mm/dd/yy)? From: To:
How will you be paying for your education?
Do you have a GED or High School Diploma?  Last grade completed:
High School Attended: Date Graduated (mm/dd/yy):
Questions / Comments?


Call us or come in today to see how much you qualify for!! (405-722-4560)

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