Form Bol-Cos-Cs-5 - Student Registration Form - Idaho State Board Of Cosmetology Bureau Of Occupational Licenses

ADVERTISEMENT

IDAHO STATE BOARD OF COSMETOLOGY
Bureau of Occupational Licenses
1109 Main Street, Suite 220
Boise, Idaho 83702-5642
(208) 334-3233
hpiippo@ibol.state.id.us
STUDENT REGISTRATION FORM
Complete this form by providing (please print) the requested information and submit it to the address noted above. The
signatures of the applicant and school agent must be notarized and the fee ($20.00) must be attached. Returned checks are
subject to a $20.00 collection fee.
NOTE: THIS COMPLETED FORM MUST BE SUBMITTED TO THE BUREAU OFFICE WITHIN FIVE (5)
DAYS OF THE APPLICANT’S FIRST DAY OF TRAINING. As noted in § 54-816, Idaho Code, the board may
either refuse to issue or renew, or may suspend or revoke, a permit or license for any of the following causes: The
conviction of a felony; Malpractice or incompetence; Continued practice by a person knowingly having an
infectious or contagious disease; False or deceptive statements in advertising; Habitual use of habit-forming drugs;
Immoral or unprofessional conduct; Submitting a fraudulent application or obtaining a license or permit through
fraud; The violation of any other provision of the cosmetology laws or rules. The board may also refuse to issue or
renew a permit or license for a person who is in default in the repayment of any student loan if, at the time the loan
was incurred, the student is provided notice of the power of the board to refuse to issue or renew a certificate or
license in the event of a default in the repayment, which notice shall be in writing and acknowledged by the
signature of the student six (6) months prior to the refusal to issue or renew a certificate or license.
I hereby submit my application to be registered as a student in: (please check applicable box(s)
[ ]Cosmetology
[ ]Nail Technology
[ ]Esthetics
[ ]Electrology
in the State of Idaho under the provisions of Title 54, Chapter 8, Idaho Code as amended.
1. Full Name (Mr., Mrs., or Ms.) ____________________________________________________________________
2. Mailing address_________________________________________________________________________________
Street
City
State
Zip
3. Place of Birth ____________________________________________
Date of Birth _______/_______/_______
month
day
year
(Proof of being 16 ½ years of age must be provided to the school. A copy of your birth certificate, passport, military ID,
or valid driver’s license is acceptable.)
4. Social Security # _____-___-_____ Home phone number (____)____________ E-mail _____________________
th
5. Do you have at least a tenth (10
) grade education or the equivalent?
[ ]Yes
[ ]No
(Proof of education must be provided to the school. i.e., a copy of your school diploma, transcript, GED, or CPAt.)
6. Name of Cosmetology school you will attend and date training will begin:
_________________________________________________________________________________________________
Name of school
Date training begins
7. Have you ever been convicted of any State or Federal felony?
[ ]Yes
[ ]No
(If yes, please attach a detailed statement, including a summary of the charges, the final order, any probation or parole
documentation, and any other relevant information.)
8. Have you received prior cosmetology training in Idaho?
[ ]Yes
[ ]No.
(If yes, please attach the name of the school you attended, your name (if different), and the dates you attended.)
(page 1 of 2)
BOL-COS-CS-59-revised 12/00

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2