Application Form

Prospective Student Application for Advanced Aesthetics Institute of Arizona

Please complete form below. Once form is submitted and the $50.00 non-refundable application fee is processed, we will get back to you at our earliest convenience and schedule next steps! We are Looking forward to meeting you!
Personal Information

Perspective Student
Full Name

First NameLast Name
Birth Date

MonthDayYear
Phone Number

Area CodePhone Number
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact

First NameLast Name
Emergency Contact Phone Number

Area CodePhone Number
Educational Background
Highest Level of Education Complete:

Other
College/ University Attended
College/University Address
Dates Attended
Year Graduated
Tell us a bit about you!

Please fill in the below.
Which Program are you interested in and why?
Do you prefer Day classes or Evening classes?
What are your goals in becoming an Aesthetician?
When are you looking to start Aestehtics School?

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Scrub Top Size
Scrub Bottom Size
T-Shirt Size
Favorite color
Favorite food
Favorite scent
Favorite drink
Favorite flower
If under 18 Years of Age:

Please provide Parent/Guardian Information:
Parent/Guardian Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Phone Number

Area CodePhone Number

Application Fee $50.00

Total $0.00

Credit Card

Apple Pay

Google Pay

ACH Bank Transfer

Student Signature:
Parent/Guardian Signature:
636 W Wickenburg Way; Suite A & E, Wickenburg, Arizona 85390

928-671-5794 info@AdvancedAestheticsInstituteArizona.com
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Prospective Student Application for Advanced Aesthetics Institute of Arizona