IMUA

Name *

First Name Last Name

Date of Birth: *

MM/DD/YYYY

Address

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

Email *

Phone number *

000-000-0000

Alternative Phone

000-000-0000

Social Security Number *

Gender

Male Female

Ethnicity

American Indian or Alaskan Native Afro American Caucasian Hispanic Asia Other

Classes *

Freelance Makeup Artistry (Full-Time) Fashion Makeup Artistry (Full-Time)

Start Date *

MM/DD/YYYY

In order to apply, students must submit a Student Application Form with a $75.00 non-refundable registration fee. The balance of tuition is due 3 days after acceptance letter unless prior arrangements have been made.

I certify that the above information is correct to the best of my knowledge. I understand that withholding information or giving false information may make me ineligible for admission to IMUA.

Signature *

First Name Last Name

Date

Date Picker Icon

Payment *

Application Fee $ 75.00

Total $ 0.00

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Interviewed by: ___________________________________ Date _________

Enrolled: ( ) Yes ( ) No Start Date __________

Program ______________

Paid in full ( ) Yes ( ) No Deposit amount $_________

Amount Due $_________ Amount Due $_________

Limitations/Comments: ___________________________________________________________________________

Click to edit this text...