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Progressive Classes Application
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Progressive Classes Application
PROGRAM INTEREST
Please select a program
Personalize Makeup Course
Masters Makeup Course
Modern Microdermabrasion
Chemical Peel Class
Hands on Massage Techniques
Brazilian Waxing
Body Waxing
GENERAL INFORMATION
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
EMERGENCY CONTACT
Name
Phone #
Relationship
Name
Phone #
Relationship
EDUCATIONAL BACKGROUND
A High School Diploma or GED equivalent is a prerequisite to enrollment in a Makana Esthetics Wellness Academy (a.k.a. Makana Academy)
programs, unless otherwise specified in the program outline. Please submit a copy of either of these documents upon enrollment.
Did you graduate from high school?
Yes
No
If no, do you have a GED equivalent?
Yes
No
Name of High School
City, State
Have you attended a Post-Secondary School?
Yes
No
Name of School
City, State
Any special emphasis courses?
What level of education have you completed? (Check all that apply)
High School Diploma (or GED equivalent)
Undergraduate Degree
Graduate Degree
Other
Do you have any education/experience related to Esthetics?
Yes
No
If yes, please explain:
Have you studied any anatomy, physiology or biology?
Yes
No
If yes, how advanced were your studies?
ESTHETICS INTEREST
How did you hear about Makana Academy? (Check all that apply)
Print Ad
Friend
Online
Career Fair
Social Media
Other
How did you decide you wanted to become an Esthetician?
Have you ever had a manicure, pedicure, facial or spa treatment?
Yes
No
What area of Esthetics are you most interested in?
Make-up
Skin care
Hair removal
Facials
Not sure
STUDENT HEALTH QUESTIONNAIRE
Do you have any health problems we should be aware of?
Yes
No
If yes, please explain:
Are you currently under a physician’s care?
Yes
No
If yes, please explain:
Are you taking any prescription or over-the-counter medication we should be aware of?
Yes
No
If yes, please explain:
Will you have any special needs or requirements while attending Makana Academy?
Yes
No
If yes, please explain:
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?
Yes
No
If yes, please explain:
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?
Yes
No
If yes, please explain:
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.
FINANCIAL RESPONSIBILITY
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 finances
I will be paying for the program with the finances of another individual* or a financial institution
Other
*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
City
State
Zipcode
DOCUMENTATION
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
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