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FULL NAME: (first, middle, last, title if applicable)
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DATE OF BIRTH: (month, day, year)
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ADDRESS (Street, City, State/Province, Postal code, Country)
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MALE/FEMALE/TRANSGENDER: (specify one)
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PHONE NUMBER (Specify day telephone number or cell#)
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EMAIL ADDRESS:
(must be a valid email address, you will receive a reply
to this form and be billed via email)
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WHERE DID YOU HEAR ABOUT THE SHOE COLLEGE, UNIVERSITE DES CHAUSSURES?
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CLASSES / PROGRAM(S) DESIRED:
(See class listings for current classes/programs)
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CLASS/PROGRAM DATES DESIRED:
(See class listings for current dates of classes/programs)
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SHOE SIZE:
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FOOT PROBLEMS? (If yes, explain)
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ANY HEALTH LIMITATIONS OR ALLERGIES? (If yes, explain)
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LIST ANY RELATED EXPERIENCE YOU MAY HAVE:
(i.e. sewing, carpentry, using power/hand tools, leatherworking etc.)
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TELL US YOUR GOALS & AMBITIONS:
(why you applied for enrollment at The Shoe College and what you expect to learn from your
course of study)
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ARE YOU CURRENTLY A STUDENT?
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Yes
No
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PLEASE TELL US WHAT MAKES YOU A GOOD CANDIDATE
FOR YOUR DESIRED PROGRAM:
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PLEASE SELECT FORM OF PAYMENT: Certified Check, Money Order or PayPal
(invoice will be sent to above email address to pay from,
should you be accepted and wish to confirm enrollment in a class)
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TUITION, ENROLLMENT & CONFIRMATION:
Upon acceptance into a class, course or program at
The Shoe College, Université des Chaussures, I agree that,
to confirm my place in the class,
I must remit the full, non-refundable tuition cost ..
I understand that I have read and understand the Terms as laid out in
the ENROLLMENT INFO page on the website.
Class size is limited to no more than 3 students. I understand that
my desired class may not be available on the date(s) desired.
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Yes
No
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LIABILITY WAIVER:
I understand that I will be working with and exposed to
potentially hazardous tools, machines and chemicals, such as sharp utility knives,
abrasives, industriel stitching machines, needles, adhesives and solvents
as well as materials that are manufactured with various chemical components.
I agree to hold harmless The Shoe College, Université des Chaussures,
its employees, owners, contractors and/or associates, for any injury or illness liability
that I may incur while at the shoe labs.
Student agrees to allow photos taken during his/her attendance
to be used by Tamera Lyndsay and The Shoe College
for educational and other purposes.
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Yes
No
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TERMINATION:
BY THE SHOE COLLEGE:
Grounds for immediate termination and expulsion are as follows:
Non-Payment of Tuition
Insubordination
Making false claims or giving misleading information in this application form
Hate Speech
Disruption of the learning environment including but not limited to texting or use of cell phones in classBY A STUDENT:
A student may cancel or terminate at any time by giving written notice to the director of the program.
Students must cancel at least 30 days prior to the 1st day of their program in order to receive
credit towards a rescheduled program. No refunds.
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Yes
No
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CONCLUSION: This agreement is not binding until accepted by the admissions dept.
of The Shoe College, Universite des Chaussures and tuition paid in full
by student named in this application. The effective date of this agreement
shall not precede today's date.
PRINT FULL NAME HERE:
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SELECT TODAY'S DATE:
I verify that I have read and I understand the Application / Agreement.
I accept and agree to the terms and conditions herein.)
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