Esthetician/Manicurist Application Form

Esthetician/Manicurist Application Form
Personal Information
Student Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Social Security Number*
Ethnicity: *
Driver's License *
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous/Current Education
School Last Attended*
Year Graduated/Last Year Attended*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Information

ONLY FILL OUT IF YOU ARE UNDER THE AGE OF 18
Parent/Guardian's Name - Primary*

First NameLast Name
Occupation*
Phone Number*
Please enter a valid phone number.
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

Clear
Emergency Contact Information
In case of emergency, who will be notified? Please answer the fields below:
Emergency Contact Person*

First NameLast Name
Emergency Phone Number*
Please enter a valid phone number.
File Upload

2x2 Colored ID Picture, Can be a drivers license or Passport
Driver's License *

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High School Transcript/GED/College Transcripts *

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Health History
If the student has any known allergies, please list them down below: *
Does the student have any medical conditions or learning challenges that you would like to declare?*
How did you hear about us?*
Course of Study
Name of Course:*
Mode of Study*

Campus (100% on Campus)Hybrid (Tuesday/Thursday on Campus)Online (100% Online)
Registration and Enrollment
Proposed Start Date*

10.15.2410.22.2411.05.2411.12.24
Class Start: Which Date Would You Like to Enroll:*
Payment Plan Option: (Pick One)*

My Products*

New Enrollment Deposit This option is for individuals who are planning on being on a payment plan. This serves as the deposit for the program. When this option is selected you are registering and enrolling in our manicurist program. The deposit is non-refundable.

$1,750.00

Transfer Student Deposit Students looking to transfer their hours. This is the option for you. This is a non-refundable deposit that sets up your online profile, orders your digital kit, and counts towards your overall balance.

$75.00 Quantity
Item subtotal:$0.00

Pay in FullAll in one Manicurist Program offering all the features to help you launch your career. This is a non-refundable deposit of $1560.

$11,750.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

I certify that the information given on this application is true and accurate to the best of my knowledge and ability. I also acknowledge that the deposit in non-refundable once this application is submitted.
I certify that I understand the above statement.
Clear
Should be Empty:

Esthetician/Manicurist Application Form

Personal Information

Previous/Current Education

Parent/Guardian's Information

Emergency Contact Information

File Upload

Health History

Course of Study

Registration and Enrollment

Credit Card