Refresher / Certification Course Training Application Form

Certification/ Refresher Training Course Signup

Participant Registration Form
Name*

First NameLast Name
E-mail*
example@example.com
Date of Birth
Phone Number*
Are You Licensed?*

YesNo
Are you currently a student enrolled in beauty school?

YesNo
If enrolled in school , what school?
Do you qualify for Arkansas Rehabilitation assistance with tuition?

YesNoIm Not Sure
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Todays Date

MonthDayYear
Date
When would you like to start?*

March 2025April 2025May 2025June 2025July 2025August 2025

Courses Available - Remainder of Balance Due 1st day of class- Payment Plans Available

Certification/ Refresher Training Course Signup