ENROLLMENT AGREEMENT

I hereby apply for enrollment in Stewart's International School for Jewelers, Inc. hereinafter referred to as "School". A representative has provided me with a catalog and explained the programs and terms of the Enrollment Agreement. I am 18 years or older or have written consent from my parent or guardian.

Name:___________________________________________Date:________________
Address:_____________________________________________________________
City:_______________________________________ State:_____ Zip:____________
Home Phone: (____) _______________ Work Phone: (____) ______________
Date of Birth:___/___/___  Social Security Number: _______________________

Past or present occupation: ___________________________________________________

Current Employer (if any) _____________________________ Phone_____________
Address: ___________________________________________________________
City: _______________________________ State: _______ Zip: ____________

Name and relationship or closest relative: ___________________________________
Address: ______________________City: ___________________ State:___Zip:________
Home Phone: (____)___________________ Work Phone: (____)______________________

How did you learn about the School?