EmailMe Form - Mosley School Of Cosmetology Pre-Application Form

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Name *

First Last

Email *

Phone *

### - ### - ####

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Race / National Origin

Gender *

Male

Female

Date of Birth *

MM / DD / YYYY

This application is for enrollment as: *

Cosmetology Program

Nail Technician Program (nails)

Esthetician Program (Makeup & Skin)

Do you have a High School Diploma or GED?

Yes

NO

Please select the course and date/time you choose to enroll. Please only select one.

(Cosmetology) Class: Dates are available during school tour.

March 14, 2022 (Esthetician) - Class Start Date:

April 8, 2022 (Esthetician) - Class Start Date:

May 2th 2022 ( Nail Technician) - Class Start Date:

Events, activities, programs and facilities of the Cosmetology School are available to all without regard to race, color, marital status, sex, religion, national origin, disability, age, Vietnam or disabled veteran status as provided by law and in accordance with the University’s respect for personal dignity.