New student Registration Form

Arkansas Institute of Esthetics

711 Towne Oaks Dr Little Rock AR 72227

ArkansasInstitute@gmail.com

www.ArkansasInstitute.com

(501) 420-7258 (text only)
New student Registration Form
Licensure Program Applying for:

Esthetics 600 Hour ProgramInstructor 600 Hour ProgramManicurist 600 Hour ( July 2025)
Certification Course Enrollment : Class Start Dates are chosen based on student availability:

Written Exam Prep Refresher Course (100 hours)Practical exam Prep Course (1 week)Lash Extensions Course (2 weeks)Dermaplane Course (2 days)Facial Techniques Course (2 weeks)Threading Certification Course (2 days)Yoni Steam Certification (2 days)Foot Detox Certification (2 days)Brow Tinting / Henna (2 days)
Esthetics & Instructor Program Start Date ( Choose ONE)

- October 15th 2024-Decemeber 3rd 2024- February 18th 2025-April 22nd 2025-June 17th 2025-August 19th 2025- October 14th 2025- January 13th 2026
Course Time*

Night Class - (Monday- Friday 5pm-10pm)Morning Class - (Monday- Wed 10am-3pm)

Education
Previous Education

Name Of High School

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Grade Completed*
Are you currently enrolled in college or another institution, if so where? *
Type N/A if not enrolled in another college or institution
Degrees or Certificates Earned
How many hours per week?

Background
Are you employed?

YesNo
If yes, where?
Household Income*
Number of Dependents in Home*
Work Schedule (days/hours)
Will you be needing financial assistance?*

YesNoMaybe
Will you need to finance & make monthly payments?*

YesNomaybe
How did you hear about us?*
We now use Ipads & Laptops each day in class to view curriculum . Do you have a personal updated Ipad or Laptop?

YesNo
If you do not have a device, would you like Arkansas Institute to add 499.00 to your tuition and provide you with a device on your first day of class ? ( If yes we will contact you with details , you will own this device )

YesNo
If you do not have a device , would you like Arkansas Institute to add 199.00 to your tuition to borrow an Ipad during school hours. (Can not leave school premises)

YesNo
Do you have reliable transportation?*

YesNo
Military Veteran*

YesNo
Do you qualify for Arkansas Rehabilitation?*

YesNoUnknown
Handicaps or Special Needs?*
Please give a brief summary of reasons for pursuing this career:*

Please give Emergency Contacts:*

	Full Name	Contact Number
1
2

Have you ever been convicted of a felony?*

YesNo
If yes , please explain. If no, please type N/A.*
Have You Ever Been Convicted of Possessing or Selling Illegal Substances?*

YesNo
Signature*

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Name*

First NameLast Name
Date*

MonthDayYear
Date

Tuition and Fees
Tuition and Fees

All tuition and fees must be paid in FULL prior to completion of clock hours, except for students who have been awarded scholarships or grants
Will you need financial assistance?*

YesNo
Would You like to pay in full and receive 15% off your tuition? (600 hour courses only)

YesNo

Scholarships
Scholarships
We’re so happy to support our Training Professionals! That’s why we offer a number of in house scholarships at Arkansas Institute of Esthetics. While grants are often need-based, scholarships are usually merit-based. Students who will not need any financial assistance will be set up on monthly payment plans. Students with financial assistance will also be set up on payment plans for the remaining balance. Students plans require a minimum of $500.00 monthly. All payments are due the 15th day of every month. Please Bring in valid ID and Transcript or Diploma after completing application. Please Come by Institute Tuesday or Wednesday after 5pm for a tour and to complete your necessary in person signatures. If you have any questions please text 501-420-7258*

I UnderstandI do not understand
Read only Enrollment Application. Please Print

Registration Fee*

Non Refundable Registration Fee / Class Deposit

$250.00

Total

$0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

Tuition and Fees