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Spring 2022 Application for Admission
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A. Personal Information
If below 18 years of age, parent will be required to sign all application/enrollment documents.
Please email
registration@chrysm.edu
for Below 18 application form.
First Name:
*
Last Name (as it appears on your government-issued ID)
*
Email Address
*
Cell Phone (include area code):
*
Alternate Phone (include area code):
Street Address:
*
City/State/Zip
*
Social Security Number:
*
Date of Birth:
*
B. Program and Schedule Selection
*Please select one class schedule. You will only be reserved a seat or added to a waitlist for ONE CLASS SCHEDULE.
*Class schedules are subject to staff availability and new schedules may be offered based on applicant request.
Esthetics (Distance Hybrid) Program
Select your preferred Esthetics class schedule.
Virginia Beach Morning, E- S22VBAM2
Virginia Beach Midday, E- S22VBMD2
Virginia Beach Late Evening, E- S22VBLE1
Hampton Morning, E- S22HAM1
Hampton Evening, E- S22HE1
Master Esthetics (Distance Hybrid) Program*
*PREREQUISITE:
Requires a valid VA Esthetics license and/or have begun VA Esthetics licensure exam process and/or enrollment in Esthetics at The Chrysm Institute* (see Getting Started Checklist for application requirements).
Select your preferred class schedule.
Virginia Beach Morning, M- S22VBAM1
C. Demographic Information
Do you claim Virginia residency?
*
Yes
No, please specify state of residency below
No, please specify state of residency below
Ethnicity:
*
Two or More Races
Asian
White
Hispanic/Latino
Black or African American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Nonresident Alien
Citizenship:
*
USA
Resident Alien (Please provide permanent resident card with application)
Other (please specify and provide applicable documentation)
D. Education
Are you currently attending or do you plan to attend another institution while enrolled at The Chrysm Institute?
*
No
Yes, I am currently attending another institution
Yes, I plan to attend another institution while enrolled at The Chrysm Institute
Have you ever taken post-secondary/college courses of any kind (community college, college/university, career/vocational school, etc.)
*
Yes
No
Please select the type of high school education you completed:
*
High School Diploma
GED
Foreign High School Diploma not obtained in the USA (requires translation & evaluation with application submission)
Please select the highest level degree completed:
Associates
Bachelors
Master/PhD
Please list all that apply
*
Dates/Semester attended
Graduation Date, if applicable
High School
Dates/Semester attended
Graduation Date, if applicable
College/University
Dates/Semester attended
Graduation Date, if applicable
College/University
Dates/Semester attended
Graduation Date, if applicable
Career/Vocational School
Dates/Semester attended
Graduation Date, if applicable
E. Esthetics Employment History (if applicable)
If you have worked in Esthetics or a related field, please list employment below:
Employer Business Name:
City/State:
Start Date:
*
End Date:
*
F. Finance
Please select planned payment type (check all that apply)
*
Financial Aid
MyCAA
Payment Plan/Cash
Be sure to fill out your FAFSA and email financialaid@chrysm.edu for information about your financial aid eligibility
G. Emergency Contact Information
Emergency Contact Name:
*
Emergency Contact Relationship:
*
Emergency Contact Phone Number:
*
Emergency Contact Email:
*
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