(Print this document, complete the form and mail or fax)

STEP 1: Fill in Enrollment Information

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.

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?

  • Stewart's Graduate
  • National Jeweler
  • Web Site
  • Jewelers Circular Keystone
  • Lapidary Journal
  • Brochure
  • Modern Jeweler
  • Pawn Brokers Magazine
  • Other

STEP 2: Choose your Program(s) and Dates

I hereby apply for admission to the Program(s) indicated below. I agree to follow your training program and upon successful completion of my studies and tuition obligation, I will be awarded an authorized diploma. All programs are one week in length, begin on a Monday and end on a Friday, and are held from 9:00 AM until 5:00 PM each day.

Start Date End Date
  • Program #1 Jewelry Repair
__________ __________
  • Program #2 Advanced Diamond Setting
__________ __________
  • Program #3 Design/Casting
__________ __________

The terms of this Enrollment Agreement are contained on two pages. Please read all pages.

Page 1 of 2 pages

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