AALA Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Phone Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Company
Enrollment Dates:

MonthDayYear
Date
Courses*
File Upload*

Please upload Current LE License & Nursing License
Cancelof
Schedule Interview Appointment
My Products
prevnext( X )
Registration Fee
2000.00 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 Deposit or Textbook, Uniform, and Kit fee.

$2,000.00

Total

$0.00
Signature*

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

Payment Methods

Debit or Credit Card

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

Student Registration Form