320 Hour Eyelash Extension Specialist Pre-Registration Form

320 Hour Course Pre-Registration

NO REFUNDS ALL TRANSACTIONS ARE FINAL!
Name

First NameLast Name
Age
Gender

MaleFemale
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
If still in High School, what grade are you in?

FreshmanSophomoreJuniorSenior
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Background: High School/GED
Dates Attended
College/University & Dates Attended
High School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email Address
Employment Background: Name of Employer, Address, Supervisor, Phone Number & Monthly Income
Financial Responsibilities
Monthly Rent, Car Payment/Insurance, Utilities
Criminal Background
Have you ever been convicted of any crime? (Misdemeanor or felony, excluding traffic tickets) This will NOT disqualify you from our program.
Are you currently taking any medications? If yes, please list them down below:
Do you have any medical conditions/allergies that you would like to declare?
Do you reside in Tyler/Smith County?
Are you currently enrolled in a cosmetology/esthetician program or you been previously trained in lash extensions?

YESNO

ALL FEES ARE NONREFUNDABLE

Application FeeNONREFUNDABLE

$60.00 Quantity

Total

$0.00

Credit Card

Apple Pay

Cash App Pay

How did you hear about us?
Reminders
INTERVIEW. The school admin will conduct an interview with the student as part of the screening test. REQUIREMENTS. It is important to send in all information in before school starts. Failure to do so may delay the student attending school. MEDICAL CLEARANCE. If you've had surgery or have been seriously ill, medical clearance is required. ACCEPTANCE: Once accepted, please remit all payments that are due.
Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty:

320 Hour Course Pre-Registration