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| Esthetics School Enrollment Form: Columbia, SC |
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OPTION 1 - Download the entire enrollment form below
Directions: please
print, fill out the entire form, and fax back to us at: (803) 739-8935 |
| < Massage Enrollment Form > |
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| OPTION 2 - Fill out the entire online form |
| Personal Information: |
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| First Name: |
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| Last Name: |
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| Address 1: |
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Phone (day): |
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| Phone (cell): |
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| Email: |
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| Social Security #: |
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| Date of Birth: |
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| Race: |
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| Marital Status: |
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| Number of Children: |
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| In Case of Emergency Contact: |
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| Phone Number: |
(123-456-7890) |
| Relationship: |
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| Education Information (Additional documentation must be submitted.) |
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| General Equivalency Diploma: |
Yes
No |
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| High School Name: |
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| Address: |
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| Years Attended |
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| Graduate |
Yes
No |
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| College: |
| School Name: |
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| Years Attended |
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| Graduate |
Yes
No |
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| Vocational Training: |
| School Name: |
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| Years Attended |
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| Graduate |
Yes
No |
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| Employment Background |
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| Current Employer: |
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| Job Title: |
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| Address: |
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| State: |
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| ZIP: |
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| Phone Number: |
(123-456-7890) |
| Contact: |
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| Previous Employer: |
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| Job Title: |
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| Address: |
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| City: |
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| ZIP: |
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| Phone Number: |
(123-456-7890) |
| Contact: |
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| Start Date: |
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| End Date: |
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| Autobiography |
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1. Discuss your purpose for enrolling in this program and what you hope to gain from it. What are your personal goals; your professional goals? Do you plan to make esthetics your career in the future? Full or Part-time?
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2.Briefly describe your work experience/life experience during the past five years (you may include a resume).
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Describe any training or prior experience you’ve had in esthetics or other related practices - either through workshops, formal training, or apprenticeships.
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Have you received a professional facial or other form of esthetic treatment before (waxing, make-up, body treatment)? Give approximate number of sessions in the past two years and describe your impression of the experience.
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5. Explain your plan for budgeting the time needed to meet the requirements of the program, both in and out of class. Please note whether you will be attending day or evening classes.
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How will the program fit into the other aspects of your life? Are your family and friends supportive?
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7.
Describe your financial situation and how you plan to meet your tuition requirements. Please be specific.
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8.
Have you ever been convicted of a crime (other than minor traffic offenses)? List dates and details. Note: A conviction record may not result in disqualification. The circumstances of each case will be considered.
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9.
How did you find out about South Carolina Massage & Esthetics Institute? Why did you choose this school?
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| Choose a Payment Option: |
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Payment in full by class start (BONUS: $100 bookstore gift certificate). |
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Pay as You Study: 50% down, balance divided by number of months in program, no interest. |
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Low Down Payment Plan: Minimum $1000 down, balance amortized over program, 12% interest. |
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SallieMae Loan: Low interest, no down payment, can borrow for additional expenses, no payment due until after graduation, can use a co-signer. |
Other. Please describe:
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| Application Agreement: |
I certify that all of the above information, and any other information provided by me in this application packet, is correct to the best of my knowledge. If accepted as a student at South Carolina Massage & Esthetics Institute, I agree that I will abide by all the rule stated in the Student Policy Handbook, which I have reviewed prior to signing this application. I further understand that the Institute will not release to any licensing board or other school, any certified hours or transcripts unless all financial and contractual obligations have been met. I have been informed that South Carolina Massage & Esthetics Institute maintains a security bond in my interest. If I withdrawal at any time and have met my obligations, South Carolina Massage & Esthetics Institute will provide me with a certified transcript of my completed hours within ten working days. In addition, the Refund Policy of South Carolina Massage & Esthetics Institute, Inc. has been fully explained to me.
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Check To Acknowledge |
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| Release Form |
In consideration of the permission granted to me to participate and appear in a visual production produced by or for the South Carolina Massage & Esthetics Institute, I hereby give my consent to prepare, use, reproduce, publish and exhibit my name, picture, portrait, likeness or voice, or any or all of them, in connection with the production of still photography, motion picture, television tape, or sound track recording in any manner for educational, scientific, informational, advertising/marketing or any other purpose deemed necessary.
I hereby waive any right that I may otherwise have to inspect or approve the finished product, or the use to which it may be put. I also release, discharge and agree to hold harmless the parties to whom this consent and waiver is given from any liability by virtue of any blurring, distortion, alteration, or use in composite form, whether intentional or otherwise, that may occur or be produced in taking of said pictures or in any processing, or in the publication and distribution. I understand that I shall receive no compensation whatsoever in connection with the foregoing beyond my opportunity to participate and I hereby waive all rights of privacy in connection with the use of my name, picture, portrait, likeness or voice. I also waive any and all rights, whether explicit or implied, in the material and consent without reservation to the Station using, distributing or otherwise making available the material to other parties as it sees fit.
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Check To Acknowledge |
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| Health History |
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Note: The Esthetics Program at SCMEI, Inc. is a demanding and rigorous process by its very nature. This Health History Form will assist the school in evaluating whether the applicant has the physical, mental and emotional resources necessary for a successful experience in the training program. All information disclosed will remain confidential; this form will be kept in the student’s permanent file.
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| Check any of the following that may apply: |
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1. Describe any past injuries, accidents, traumas or surgeries you have experienced. Please list approximate dates for each, and the treatment(s) you received.
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Describe any and all diagnosed medical conditions you currently have. Be specific and detailed. List when the condition was diagnosed, and any treatment(s) you are currently receiving.
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Are you currently under a physician’s care (medical doctor, chiropractor, osteopath, naturopath)?
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Yes
No |
If yes, list each provider’s name, address and phone number.
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List any prescription medications you are taking for these conditions.
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Do you have any known history of physical or sexual abuse?
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Yes
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Have you been treated for alcohol, drug or substance abuse?
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Yes
No
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If yes, list any counseling or treatment you have received, along with the dates of treatment and the name of the provider.
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Describe any and all diagnosed psychological or emotional conditions you currently have. Please be specific and detailed. List when the condition was diagnosed and any course of treatment you have received previously for this condition OR treatment you are currently receiving.
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List any prescription medications you are taking for these conditions.
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Are you working with a counselor, psychologist, psychotherapist, social worker or psychiatrist at present?
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Yes
No |
If yes, list each provider’s name, address and phone number.
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Do you have any diagnosed learning disabilities?
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Yes
No |
If yes, list the condition, along with the treatment.
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Describe any difficulties/challenges you have with either classroom learning or at-home study work.
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I verify that I have considered my health and my ability to complete a program in esthetics at South Carolina Massage & Esthetics Institute, and will not hold SCMEI, Inc. liable for any preexisting conditions that may limit my ability to perform esthetics services. I have completed this form as part of the Application Packet to the best of my knowledge and I state that the information given here is true and correct.
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Check To Acknowledge |
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Notice of Nondiscrimination Policy:
South Carolina Massage Therapy Institute admits students of any sex, race, color, religion, nationality, sexual orientation, ethnic origin or physical disability in the administration of its educational policies or other school administered programs. We at South Carolina Massage & Esthetics Institute are committed to the education, healing and care of all human beings. The work we do transcends any type of discrimination. The staff and faculty at South Carolina Massage & Esthetics Institute welcome diversity in the student body.
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In order to complete your enrollment the documents below must be downloaded, filled out, and faxed to (803) 739-8935.
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| Letter of Recommendation <Letter of Recommendation.pdf > |
| Facial Verification < Facial Verification.pdf > |
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