Application for



PREMIERE AESTHETICS INSTITUTE prohibits discrimination against its customers, employees, employment applicants, students and student applicants on the bases of race, color, national origin, age, disability, sex, gender identity, religion and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, participation in any public assistance program, or any protected genetic information.  Discrimination is prohibited in any program or activity conducted for, or funded by, PREMIERE AESTHETICS INSTITUTE.

This application form must be completed and submitted by the Application Submission Deadline listed below for the Class Start Date desired.  In addition to this application form, the applicant's must submit a copy of their current driver's license, a copy of an additional form of identification and a copy of their high school diploma or GED. 

An applicant whose check is returned for insufficient funds will be charged an additional fee of $25.


Program Tuition $10,500

Address *
Phone *
Date of Birth *
Date of Birth
Are you a U.S. Citizen? *
How did you hear about us? *
Have you ever applied to this school before? *
Have you ever attended this school before? *
If you have attended this school before, did you graduate?
Which location are you interested in attending? *
Have you served in the U.S. military? *
If you have served in the U.S. military, were you discharged honerably?
Emergency Contact Information
Name *
Address *
Phone *
Secondary Education *
I have completed the following postsecondary education: *
Check all that apply
Are you currently employed? *
Program Interest
I am pursuing admission for the following reason *
I intend to enroll in the following program(s) *
Select all that apply
The information requested in this section is not required for admission. Submission of the information in this section is entirely voluntary. Information submitted voluntarily will not affect your admission to the school. The information, if supplied, will be used for monitoring equal educational opportunity. In addition, note that if you are disabled, you may voluntarily self-identify for the purpose of requesting reasonable accommodations during the entire application and admission process. If you are an English language learner or limited English proficient you may also voluntarily self-identify for the purpose of receiving interpretive services during the entire application and admission process.
Person with disability
Person who is an English language learner or limited English proficient
I understand that the State of Oregon Board of Cosmetology requires that I have 600 hours of training, as well as pass a written practical exam at the end of the program in order to receive my license in Esthetics and practice. I certify that by entering my full name and date below, and by submitting this application that all statements on this application and accompanying documents are complete and true. I also understand that if I am admitted and do not enroll for the "start date" to which I am admitted, I may need to reapply for admission. I understand that submitted materials will not be returned or duplicated. The statements and information furnished by the undersigned in this application form are true and complete. My signature certifies that I have read and agree with the statements in the application form.
Type your full, legal name
Student Signature Date *
Student Signature Date
Enter todays date

Please note: PREMIERE AESTHETICS INSTITUTE is an authorized Phytoceane™, Jane Iredale™ and Clean + Easy™ training facility.  Regardless of whether it is your intention to practice any type of procedure in your geographic region, upon successfully obtaining a PREMIERE AESTHETICS INSTITUTE completion diploma, it is solely your responsibility to ensure that your state of intended practice, as well as the local government (city and county), recognizes our completion certification as a valid and legal license to practice in any capacity in the esthetic field.