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REQUEST INFORMATION

• Program of Interest*
  Tom Savini's Special Make-Up Effects ProgramGeorge A. Romero's Filmmaking ProgramCosmetology ProgramEsthetics ProgramEsthetician and Nail Technologist ProgramMassage Therapy ProgramAdvanced Cosmetic TechniquesCommercial Driver's License ProgramHeavy Equipment and CDL with Safety
• Contact Information*
  First Last
• Email*
• Phone*
• Preferred Pronouns*
  She/Her/HersHe/Him/HisThey/Them/TheirsOtherNo Preference
• Date of Graduation or GED (approximate date) MM/DD/YYYY*
  MM slash DD slash YYYY
• City*
• State*
  ALAKASAZARCACOCTDEDCFMFCFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPUNOHOKORPWPAPRRISCSDTNTXUMUTVTVAVIWAWVWIWYOut of the USA
• Zip Code*
• Country*
• Preferred Method of Contact*
  Text MessagePhone CallEmail
• How did you hear about Douglas Education Center?*
• Start Date*
  As Soon as PossibleOctoberFebruaryJuneOver a Year
• Do you have an online portfolio of your work? We would love to see it! (NOT REQUIRED FOR ENROLLMENT) Enter your portfolio link here:
• If you know anyone who has attended our school, please let us know who and give a brief explanation below:
• Please confirm*
  • By Pressing SUBMIT, I give consent to Douglas Education Center, and their agents, to contact me by email or telephone (both mobile and home, including pre-recorded and/or using auto-dialers) at the number I have provided above to receive marketing information about Douglas Education Center’s programs, and offers. I understand that my consent to receive SMS text messages is not required to get a quote or to enroll at Douglas Education Center, or its affiliated schools or companies, and that I may instead call 724-684-7463 to proceed without giving this consent.

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