Student Application

First Name

Last Name

Phone

Alternate Phone

Email

Parent's Email

Birth Date

Street Address

Apt/Suite

City

State/Province

Zip/Postal Code

Country

Social Security Number

Gender Gender Male Female Other

Citizenship Citizenship U.S. Citizen Permanent Resident International

Program, Class, or Teen Camp? Program, Class, or Teen Camp? Program Class or Workshop Teen Camp

Teen Camp Dates? Teen Camp Dates? July 8 - 12 July 15 - 19 July 22 - 26 July 29 - August 2 All 4 Weeks July 8 - Aug 2

Which Program do You want to Attend? Which Program do You want to Attend? Master Makeup Artistry Pro Master Makeup Artistry Fashion Makeup Artistry Skin Care

Which Class do You want to Attend? Which Class do You want to Attend? Special FX Courses Basic Beauty Module Fundamental Makeup Technique Airbrushing Class Wedding & Event Class Character Module Brow Workshop Haunt School Lash Extensions

Please fill in the start date:

Program Start Date? Program Start Date? January March May August October

Class Start Date?

Do you have a High School Diploma? Do you have a High School Diploma? I have a High School Diploma I have a G.E.D. or equivalent I do not have the above documents

Are you a Licensed Cosmetologist or Esthetician? Are you a Licensed Cosmetologist or Esthetician? Yes No

Please check (Statistical use only for State Agencies) Please check (Statistical use only for State Agencies) American Indian Caucasion Black Asian or Pacific Islander Hispanic Other

Foreign Students Only- All applicants who enter the U.S. on a student visa must complete the following questions about financial support. What is your source of financial support (SELECT ONE): Foreign Students Only- All applicants who enter the U.S. on a student visa must complete the following questions about financial support. What is your source of financial support (SELECT ONE): Self Family Member Parent Friend

Select Your Tuition Payment Option: Select Your Tuition Payment Option: 1. Pay Cash (Cash, Check, Florida Pre-Pay, Vocational Rehab) 2. Short-Term Payments (Monthly Payments while in School- Interest Free) 3. Long-Term Payments (Monthly Payments 12 – 72 Months 3%-9% Interest. Payments cover Tuition Only. There is a $25 application fee)

Employer's Name

Total Monthly Income

Employer's Address

Length of Employment

Employer's Apt/Suite

Employer's City

Employer's Zip Code

Employer's State

Employer's Phone Number

Are You Applying with a Cosigner? Are You Applying with a Cosigner? Yes No

Cosigner's First Name

Account Holder's Name

Cosigner's Last Name

Cosigner's Address

Cosigner's Apt/Suite

Cosigner's City

Cosigner's State

Cosigner's Zip/Postal Code

Cosigner's Date of Birth

Cosigner's Email

Cosigner's Phone

Cosigner's Social Security Number

Cosigner's Credit Report Authorization Cosigner's Credit Report Authorization I authorize Cosmix to run a Credit Report

Cosigner's Signature

There is a $100 non-refundable registration fee and an additional $25 fee for a credit report for those choosing long-term payment plans. These are exempt from any additional credit card fees. Other payments are subject to a 2.9% credit card convenience fee. There is a $100 non-refundable registration fee and an additional $25 fee for a credit report for those choosing long-term payment plans. These are exempt from any additional credit card fees. Other payments are subject to a 2.9% credit card convenience fee. I authorize Cosmix to run my credit card.

Credit Card Number

Name on the Card

Expiration Date

Security Code (CVV)

Student's Signature