APPLICANT INFORMATION

Country

EDUCATIONAL BACKGROUND

PROFESSIONAL EXPERIENCE

LICENSURE (IF APPLICABLE)

STATEMENT OF INTEREST

CAREER GOALS

REFERRAL SOURCE

ILLINOIS COMPLIANCE & REGULATORY DISCLOSURE

Skinflection’s Institute of Laser Training operates in accordance with the laws and regulations of the State of Illinois.

Laser and energy-based device procedures in Illinois are regulated by the Illinois Department of Financial & Professional Regulation (IDFPR) and must be performed in compliance with applicable statutes, rules, and supervision requirements.

Applicants acknowledge and understand that:

Completion of a laser training program does not automatically grant the legal authority to perform laser procedures independently in the State of Illinois or in any state of residence.

Scope of practice varies based on professional licensure, training, and physician oversight, as required by Illinois law. Certain laser procedures may require medical supervision, delegation, or employment under a licensed physician or medical director.

It is the responsibility of the applicant to understand and comply with residency state laws, facility protocols, and employer requirements related to laser services.

Skinflection’s Institute of Laser Training provides education and certification of competency but does not guarantee licensure, employment, or independent practice rights.

ACKNOWLEDGEMENT OF ILLINOIS REQUIREMENTS

By signing below, I acknowledge that I have read and understand the Illinois compliance disclosure above.

I agree to comply with all applicable federal, state, and local laws governing laser and energy-based device treatments in Illinois.

I understand that Skinflection’s Institute of Laser Training is not responsible for changes in state regulations or individual scope-of-practice determinations.

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CANDELA DEVICE TRAINING ACKNOWLEDGMENT

I acknowledge that Skinflection’s Institute of Laser Training partners with Candela to provide hands-on education using Candela laser and energy-based devices.

I understand that:

Training on Candela devices is educational in nature and does not constitute authorization to use such devices outside of legal and regulatory requirements.

Certification of training does not replace manufacturer credentialing, employer-specific training, or state-required supervision.

Candela participation does not imply endorsement of employment, licensure, or independent practice.

PHOTO & VIDEO CONSENT

I grant permission to Skinflection’s Institute of Laser Training to photograph and/or record video of me during training sessions, classes, and practical demonstrations.

I understand that these images or recordings may be used for educational, marketing, promotional, and social media purposes, including but not limited to websites, advertisements, and social platforms.

I release Skinflection’s Institute of Laser Training from any claims related to the use of such media and understand that no compensation will be provided.

REFUND & CANCELLATION POLICY ACKNOWLEDGMENT

I understand that tuition, deposits, and fees are subject to Skinflection’s Institute of Laser Training’s Refund and Cancellation Policy stating that:

Certain fees may be non-refundable, including deposits and administrative costs.

Failure to attend, withdrawal, or dismissal from the program may result in partial or no refund, depending on timing and circumstances.

Refunds, if applicable, will be issued according to the stated policy and timeframe.

NON-GUARANTEE OF EMPLOYMENT

I understand and acknowledge that completion of a program at Skinflection’s Institute of Laser Training does not guarantee employment, job placement, licensure, income level, or independent practice opportunities

FINAL STUDENT ACKNOWLEDGEMENT & SIGNATURE

By signing below, I confirm that I have read, understand, and agree to all disclosures, policies, and acknowledgements contained in this application and enrollment materials.

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that submission of this application does not guarantee acceptance into the program.

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