Course Registration Form

Student Registration Form

Please fill out completely.
Do you have a High School Diploma or GED (Yes or No)*
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Student E-mail*
Mobile Number*

Area CodePhone Number
Phone Number*

Area CodePhone Number
Schedule*
Classes*

ManicuristEstheticianEsthetician/ManicuristBarber/Cosmo
Additional Comments
Upload your current VALID drivers license*

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Upload your High School Diploma, GED or transcripts*

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Registration Fee$169.00
(non-refundable)

Total $0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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