SSE Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Company
Enrollment Dates:

Month Day Year
Date
Enrollment Dates:

Month Day Year
Date
Enrollment Dates:

Month Day Year
Date
Enrollment Dates:

Month Day Year
Date
Enrollment Dates:

Month Day Year
Date
Courses *
*Please choose: Traditional Full Time Day or Part Time Evening
Times *
File Upload *

Please upload High School Diploma or GED Certificate If applicable, Social Security Card, and Current Drivers License/ID with Birth Date.
Cancel of
Schedule Interview Appointment

Registration Fee

USD $199.00 Esthetics Registration Fee/ $250 Esthetics Instructor Registration Fee/ $600 Advanced Medical Esthetics Registration Fee prior to Enrollment which will reserve a space in the class on your desired start date. Which is Non-Refundable and DOES not include your Textbook, Uniform, and Kit fee.

Credit Card

Signature *

By signing this application you agree to enroll in Shelby School of Esthetics and pay a non - refundable application fee. Clear
Additional Comments
Should be Empty:

Student Registration Form

Credit Card