mequon thiensville school of esthetics work station

mequon thiensville school of esthetics

Committed to enriching your life by providing a solid skin care
program with the most updated materials and equipment!

Center for Advanced Esthetic Training

Application Form

Please print this form and fill out completely.

Applicant Name: ___________________________________________

Address: __________________________________________________

City: _____________________________ State: _________ Zip: ____________

Phone: ______________________________ Alt. # ________________________

E-mail address: _____________________________________

Personal History:

Social Security # ________________________ Date of Birth: __________________

Age: _____ Sex: ______ Marital Status: Single____ Married ____ Other ____

Spouses Name: __________________________ Number of Dependents: ______

Education: (Circle last grade completed)  8   9   10   11   12   13   14   15   16   Degree: _____
Indicate if any of these apply: High School Diploma ___ Equivalency Diploma ___College ___

How is your general health? ___________________________    

Do you have any physical disabilities? _________

Are you under a physicians care?  Yes _____   No ______

Are you on any medications or substances? __________

If yes, please list______________________________________________

Father's Name: ______________________________ Telephone # _________________

Address: ______________________________ City/State/Zip Code: ________________

Mother's Name: _____________________________ Telephone # __________________

Address: _______________________________ City/State/ Zip Code: _______________

Name of nearest relative __________________________ Telephone # ________________

Give two (2) references that we may contact by letter or telephone:

1. Name _______________________________ Title __________ Relationship ________

Address ________________________________________ Telephone # ______________

2. Name ________________________________ Title _________ Relationship ________

Address ________________________________________ Telephone # ______________

General Information:

How were you referred to Mequon/Thiensville School of Esthetics?

________________________________________________________________________

Why do you want to attend a school of esthetics?

_________________________________________________________________________

What aspects of skin care interest you? Rate your interests from 1 (most) to 8 (least)

Facials _____ Makeup _____ Nutritional Therapy _____ Massage _____

Waxing _____ Body Treatments _____ Equipment Usage _____

What do you expect your future salary to be as an Esthetician?

Upon graduation: $_____________ Two (2) years after graduation: $__________________

How did you become interested in the field of esthetics?

___________________________________________________________________________

What are your goals in the field of esthetics?

____________________________________________________________________________

What are your expectations of this program?

____________________________________________________________________________

My signature certifies that the above information is correct.

_____________________________________________     _________________________
Applicant's Signature                                                                 Date

_____________________________________________     _________________________
Interviewer's Signature                                                               Date

Please send completed application form with enrollment and registration fee of $100.00 to:
Mequon Thiensville School of Esthetics, 214 Green Bay Rd., Thiensville, WI 53092.