Name *

First Name

Last Name

Phone

(###)

###

####

What course are you interested in? *

Cosmetology Training

Instructor Training

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a U.S. Citizen? *

Yes

No

Are you a High School graduate? *

Yes

No

Post Secondary Education?

Yes

No

Military Veteran

Yes

No

Are you interested in applying for financial aid? *

For Federal Financial Aid, a FAFSA must be completed and signed by the student prior to enrollment.

Yes

No