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program of interest*
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first name*
last name*
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Enrollment Application

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Enrollment Application

PLEASE SELECT YOUR CAMPUS:

PLEASE SELECT YOUR CAMPUS:*

Cedar Falls

Cedar Rapids

Davenport

Des Moines

Fort Dodge

PLEASE SELECT YOUR PROGRAM:

PLEASE SELECT YOUR PROGRAM FOR Cedar Falls:*

Cosmetology

Massage Therapy

Esthetics

Nail Technology

Teacher Training

PLEASE SELECT YOUR PROGRAM FOR Cedar Rapids:*

Cosmetology

Massage Therapy

Esthetics

Nail Technology

Teacher Training

PLEASE SELECT YOUR PROGRAM FOR Davenport:*

Cosmetology

Massage Therapy

Esthetics

Nail Technology

Teacher Training

PLEASE SELECT YOUR PROGRAM FOR Des Moines:*

Cosmetology

Massage Therapy

Esthetics

Nail Technology

Teacher Training

PLEASE SELECT YOUR PROGRAM FOR Fort Dodge:*

Cosmetology

Massage Therapy

Esthetics

Nail Technology

Teacher Training

Program Start Date*

Shirt Size: (Small to 4XL)*

Cosmetology Students Only, Choose Shears:*

Left hand

Right Hand

N/A

Do you have a current license in the Health and Beauty Field?*

Yes

No

If yes, check licenses:

Cosmetology

Nail Technology

Esthetics

Massage Therapy

CONFIDENTIAL GENERAL INFORMATION

Legal First Name:*

Legal Last Name:*

Cell Phone:*

Secondary:

Social Security #:*

Driver’s License/State ID #:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Birth Date:*

MM slash DD slash YYYY

E-mail Address:*

Marital Status (check one):*

Married

Widowed

Single

Separated

Divorced

Have you ever legally changed your name:*

Yes

No

If so, please provide all prior names:

Citizenship Status:*

U.S. Citizen

Eligible Non-Citizen

Non-Citizen

EMERGENCY CONTACT:

Emergency Contact*

Phone #*

Relation*

EDUCATION:

EDUCATION*

High School Diploma

GED

HSED

Home School Completion

English-Translated Qualified Foreign High School Diploma

Name of High School Attended:*

Year Graduated:*

Have you previously attended (select all that apply):

College

Career College

Vocational

Year Completed:

Did you receive a Degree or Certificate?*

Yes

No

Name of College Attended:

Name

City

State

FINANCIAL AID

Will you be applying for financial aid?*

Yes

No

Unsure

Have you ever received federal financial aid previously at another college?*

Yes

No

Unsure

Please list any other funding sources you may be eligible to receive:

(Example: Veterans Benefits, Scholarships, Vocational Rehabilitation, College Savings Plan, etc.)

DEMOGRAPHICS

Various governmental agencies require private postsecondary educational institutions to compile statistics on the institution’s student population. Information requested on this questionnaire will be kept confidential and will be used only to compile information for the purposes described above. Completion of this section in no way affects any decision regarding admission to any of the academic programs.

PLEASE CHECK ONE:*

Non-Resident Alien

Hispanic/Latino

American Indian/Alaska Native

Asian

Black or African American

White

Native Hawaiian/Pacific Islander

Two/More Races

Race/Ethnicity Unknown

Gender Identity on Government Photo ID*

Male

Female

Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training?*

Yes

No

Are you a veteran of the U.S. Armed Forces?*

Yes

No

Are you eligible to receive CH 31, CH33 or CH 35 Veteran’s Benefits?*

Yes

No

Do you currently or will you have children who will receive more than half of their support from you?*

Yes

No

If yes, how many?

At any time since you turned age 13, were both your parents deceased, were you in foster care or were you a dependent or ward of the court?*

Yes

No

As determined by a court in your state of legal residence, are you or were you an emancipated minor?*

Yes

No

Does someone other than your parent or stepparent have legal guardianship of you, as determined by a court in your state of legal residence?*

Yes

No

At any time on or after July 1, 2024, did any of the following entities certify that you were an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless: your high school, a school district homeless liaison, an emergency shelter or transitional housing program or a direct of a runaway/homeless youth center?*

Yes

No

While you are in school what are your housing plans?*

Living with parent

Living off campus

The information on this application is correct to the best of my knowledge. I understand that my enrollment is dependent upon its accuracy and verification. This application will not be processed until receipt of application fee payment. The application fee is non-refundable. Please submit this application to the La’ James International College you plan to attend.

Applicant Signature*

Where did you hear about La’ James International College?

La’ James International Graduate/Name:

Salon Owner/Name:

Friend/Name:

Guidance Counselor/Hight School Information.

Radio

Website/On-Line/social media

La’ James International Representative

Other:

Do you know anyone who would benefit from a career in one of our programs?

Name:

Address:

City:

Cell Number:

High School Grad Year:

E-mail:

How would you like to pay?*

Pay on Campus

Pay with PayPal

Total

Payment Method

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

See What Our Students Have To Say

I would recommend everyone come to LJIC because you get to meet a lot of new people and this field can take you anywhere.

Alexis L.

Alexis L.

Recomendaría a todos que vinieran a LJIC porque pueden conocer a mucha gente nueva y esta área puede llevarlos a cualquier parte. Alexis L.

Alexis L. – Spanish

Our Partners

Fort Dodge

2419 5th Avenue South
Fort Dodge, Iowa 50501

CAMPUS HOURS
Sunday: Closed
Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 9:00am - 5:00pm
Thursday: 10:00am - 8:00pm
Friday: 9:00am - 5:00pm
Saturday: 9:00am - 2:00pm
*Appointments Recommended*

Get Directions Schedule A Tour View Services

Cedar Falls

6322 University Avenue
Cedar Falls, Iowa 50613

CAMPUS HOURS
Sunday: Closed
Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 9:00am - 5:00pm
Thursday: 10:00am - 8:00pm
Friday: 9:00am - 5:00pm
Saturday: 9:00am - 2:00pm
*Appointments Recommended*

Get Directions Schedule A Tour View Services

Cedar Rapids

4444 1st Ave NE #12
Cedar Rapids, Iowa 52402

CAMPUS HOURS
Sunday: Closed
Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 9:00am - 5:00pm
Thursday: 10:00am - 8:00pm
Friday: 9:00am - 5:00pm
Saturday: 9:00am - 2:00pm
*Appointments Recommended*

Get Directions Schedule A Tour View Services

Davenport

5205 North Brady Street
Davenport, Iowa 52806

CAMPUS HOURS
Sunday: Closed
Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 9:00am - 5:00pm
Thursday: 10:00am - 8:00pm
Friday: 9:00am - 5:00pm
Saturday: 9:00am - 2:00pm
*Appointments Recommended*

Get Directions Schedule A Tour View Services

Des Moines

8805 Chambery Boulevard
Johnston, Iowa 50131

CAMPUS HOURS
Sunday: Closed
Monday: 9:00am - 5:00pm
Tuesday: 9:00am - 5:00pm
Wednesday: 9:00am - 5:00pm
Thursday: 10:00am - 8:00pm
Friday: 9:00am - 5:00pm
Saturday: 9:00am - 2:00pm
*Appointments Recommended*

Get Directions Schedule A Tour View Services

Select Location:

Fort Dodge
Cedar Falls
Cedar Rapids
Davenport
Des Moines

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