Application - Cosmetic Therapy Training Center

Applicant Information
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Name*

First NameMiddle NameLast Name
Today's Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Are you a US Citizen?*

YesNo
Have you ever been convicted of a felony?*

YesNo
Social Security Number

Education
Education 1
High School*
Address*
From Date*

MonthDayYear
Date
To Date*

MonthDayYear
Date
Did you graduate?*

YesNo
Degree*
Education 2
College*
Address*
From Date*

MonthDayYear
Date
To Date*

MonthDayYear
Date
Did you graduate?*

YesNo
Degree
Education 3
Other
Address
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Did you graduate?

YesNo
Degree

Legal Agreement
Click here to download our legal agreement.
I Accept*

Yes

Payment Information

Application Fee

Registration Fee$150.00

Cosmetic Therapy Training Center Registration Fee

Total $0.00

Credit Card

Should be Empty: