Informational Interview Request Form

First Name: *
Last Name: *
Street Address: *
City: *
State: *
ZIP Code: *
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Contact Method: * Home Phone
Work Phone
Cell Phone
E-mail
Date of Birth:
Program(s) of Interest: * Cosmetology - Day Program
Cosmetology - Night Program
Esthiology - Day Program
Esthiology - Night Program
How did you hear about us? *
Select each of the days you are available: * Monday
Tuesday
Wednesday
Thursday
Friday
Select each of the times you are available: * 9:00 am
10:00 am
11:00 am
1:00 pm
2:00 pm
3:00 pm
4:00 pm
5:00 pm
6:00 pm


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2828 N. Clark Street • Chicago, Illinois 60657 • 1-773-883-1560