Please select a programPersonalize Makeup CourseMasters Makeup CourseModern MicrodermabrasionChemical Peel ClassHands on Massage TechniquesBrazilian WaxingBody Waxing
First Name
Last Name
Date of Birth
Drivers License #
State Issued In
Mailing Address
City
State
Zipcode
Home Phone #
Cell Phone #
Email Address
Occupation
Employer
Name
Phone #
Relationship
Did you graduate from high school?YesNo
If no, do you have a GED equivalent?YesNo
Name of High School
City, State
Have you attended a Post-Secondary School?YesNo
Name of School
Any special emphasis courses?
What level of education have you completed? (Check all that apply)High School Diploma (or GED equivalent)Undergraduate DegreeGraduate DegreeOther
Do you have any education/experience related to Esthetics?YesNo
If yes, please explain:
Have you studied any anatomy, physiology or biology?YesNo
If yes, how advanced were your studies?
How did you hear about Makana Academy? (Check all that apply)Print AdFriendOnlineCareer FairSocial MediaOther
How did you decide you wanted to become an Esthetician?
Have you ever had a manicure, pedicure, facial or spa treatment?YesNo
What area of Esthetics are you most interested in?Make-upSkin careHair removalFacialsNot sure
Do you have any health problems we should be aware of?YesNo
Are you currently under a physician’s care? YesNo
Are you taking any prescription or over-the-counter medication we should be aware of? YesNo
Will you have any special needs or requirements while attending Makana Academy? YesNo
Do you have any allergies or medical conditions which may prevent you from receiving and/or giving hands-on treatments during the practical portion of this program?YesNo
Do you have any condition (i.e. physical, emotional or otherwise) that we should be aware of and/or may prevent you from full participation in your program at Makana Academy?YesNo
Prospective students should be aware that full participation in esthetic treatments, both giving and receiving, is a requirement for satisfactory progress and program completion at Makana Academy. Prospective students must understand that without a physician’s certification, failure to participate fully in clinical treatments and practical experience, will adversely affect your grades. This may even affect your ability to complete the program and graduate from Makana Academy. Any condition that may prevent full participation must be fully disclosed prior to your enrollment. Makana Academy must be given the opportunity to accommodate you during your program. Please attach a physician’s certification describing your condition and how it would affect your ability to fully participate.
How do you intend to pay for your education at Makana Academy? (Please check one) I will be paying for the program with my own financesI will be paying for the program with the finances of another individual* or a financial institutionOther
*If another individual (parent, guardian or other) will be financially responsible for your tuition, please provide the following information:
Name of Guarantor
Phone Number of Guarantor
Address of Guarantor
The following documents are required to be submitted or the application will be considered incomplete. Prospective students may submit the completed application first, and then submit the required documents separately. However, all documentation must be submitted no later than 14 calendar days prior to the start date of the selected program. Please bring your required documents with you at your tour appointment.
Documentation Requirement
High School Diploma or GED Equivalent
Physician’s Certification (if applicable, see Student Health Questionaire)
PLUS, any two (2) of the following:
Birth Certificate
Drivers License
Social Security Card
State Issued Photo ID
U.S. Passport
To the best of my knowledge, this application has been completed with true and accurate information. I understand that supplying false information on any portion of this application may result in the rejection of this application or may result in expulsion from Makana Academy if this information is found false at any time during my enrollment. Before submitting your application, please review it to ensure that each section has been completed accurately and in its entirety. If a question or section of this application does not apply to you, please mark it with N/A. Do not leave any sections blank. All requested documentation is required to be submitted during the enrollment process
Agree
