Contact Information

First Name:*

Last Name:*

E-Mail:*

Home Phone:

Mobile:*

Cell Phone Company (e.g. Verizon, T-Mobile, AT&T, etc.)*

Program:*

Are you over 18 years of age?*

Which schedule are you interested in attending?

Day - Cosmo/Mani (Tues-Sat 8am-3:30pm)

Day - Esthetics (Tues-Sat 8am-2:30pm)

Evening - All Programs (Mon-Fri 5pm-10pm)

How Did You Hear About Our School?*

Please Specify:*

Referrer

What is your state of residence?*

Address:*

Unti/Suite#

City:*

ZipCode:*

Country:*

Do you live with your parents?*

Are you a US Military Veteran?*

You will have to show proof in the form of a diploma or transcripts.

Are you a high school graduate or have a GED?*

What is your highest level of previous education?*

Have you EVER attended ANY school for Cosmetology/Esthetics/Manicuring?*

Palomar Institute of Cosmetology's annual security report is available online. This report is required by federal law and contains policy statements and crime statistics for the school. The policy statements address the school’s policies, procedures and programs concerning safety and security, for example, policies for responding to emergency situations and sexual offenses. Three years’ worth of statistics are included for certain types of crimes that were reported to have occurred on campus, in or on off‐campus buildings or property owned or controlled by the school and on public property within or immediately adjacent to the campus. This report is available online at http://www.pic.edu/pdf/PIC_Crime_Statistics.pdf. You may also request a paper copy from the Administrative Office.

I hereby certify that the above statements are true and correct*

By submitting this form, I agree that Palomar Institute of Cosmetology may call, text and/or email me. Message and data rates may apply. Text STOP to opt out or HELP for help.