Certified Medical Aesthetician Application

Applicant Information
Applicant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Aesthetic License Number*
Tuition Options
You may pay your Tuition ($20,000) and Student Kit Fee ($2,500) up front or over time with approved financing. Base on your creditworthiness, you can choose monthly payments to fit your bidget over 24-60 months.

The following is only an estimate and will be adjusted based on any scholarships, awards, discounts, or interest fee applied. Please select your desired pyament schedule.
Please Select a Tuition Option*

60 Month Pay: $375.00/mo48 Month Pay: $468.75/mo24 Month Pay: $937.50/moSingle Pay: $20,000
Training & Attendance Limitations
Please list anything that could interfere with your training or attendance (physical limitations, emotional or mental conditions, medications, caregiver responsibilities, substance abuse, or transportation limitations).*
Education & Employment History
What is your highest level of education?*
Are you currently employed?*

YESNO
Supervisor's Name

First NameLast Name
Supervisor's Phone
Please enter a valid phone number.
Please provide two professional references. (Non-relatives)
Reference #1 Name*

First NameLast Name
Reference #1 Phone*
Please enter a valid phone number.
Relationship of Reference #1
Reference #2 Name*

First NameLast Name
Reference #2 Phone*
Please enter a valid phone number.
Relationship of Reference #2
Tell us more about yourself
Why are you interested in becoming a Certified Medical Aesthetician?*
What are your personal and professional goals inside the aesthetics industry after receiving your certification?*
Background Check
Do you consent to a background check?*

YESNO
Resume Upload
Please upload your latest resume*

Cancelof
Acknowledgements
Please read the following acknowledgements and mark that you have read and agree to each of them
My application will be processed after the application fee is paid.*

Acknowledge
Submitting this application does not guarantee acceptance to The Aesthetic Institute.*

Acknowledge
TERMS & CONDITIONS
I have read and agree to the Terms & Conditions set forth by The Aesthetic Institute for becoming a student.*

Acknowledge
Sign and Submit Application
I certify that the facts set forth in this Application for Enrollment are true and complete to the best of my knowledge. I understand that if I am accepted into the program, false statements, omissions or misrepresentations may result in my dismissal without refund. I authorize The Aesthetic Institute to make an investigation of any of the facts set forth in this application and release The Aesthetic Institute from any liability.
Signature*

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Date Signed*

MonthDayYear
Date
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Applicant Information

Tuition Options

Training & Attendance Limitations

Education & Employment History

Tell us more about yourself

Background Check

Resume Upload

Acknowledgements

Sign and Submit Application