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IDAHO STATE BOARD OF COSMETOLOGY

BUREAU OF OCCUPATIONAL LICENSES

1109 MAIN STREET, SUITE 220

BOISE, IDAHO 83702-5642

(208) 334-3233

APPLICATION FOR STUDENT DEMONSTRATOR PERMIT

Name of Sponsoring Entity(s)_________________________________________________________________________________

Name of Event ____________________________________________________________________________________________

Address of Event __________________________________________________________________________________________

street

city

state

zip

to be held from _____________________ to ______________________, inclusive.

beginning date

ending date

Sponsor’s Phone #______________________

Application must be made no less than seven (7) days prior to the beginning date noted above.

All permits issued as a result of this application shall expire on the ending date noted above.

I hereby make application for Student Demonstrator Permits for the following persons:

Name _____________________________ Name _____________________________ Name _____________________________

Name of Cosmetology School in which above students are enrolled:

________________________________________________________________________________________________________

The permit fee of $10.00 must be attached.

I hereby certify that those named above are currently enrolled as students and are engaged in a program of instruction in

cosmetology and shall be under the supervision of a licensed instructor at all times;

I further certify that I have read and agree to abide by the Idaho Laws & Rules governing the practice of cosmetology;

I further certify that prior to any demonstration or instruction at the event noted, I will inform each of the students named above of

the sanitary rules for shops and schools;

I further certify that all services provided at the event noted above will be for educational or demonstration purposes only;

I further certify that during the event noted the required facilities and products necessary to properly clean and sanitize instruments

will be available to the students named above; Said facilities and products shall include access to hot and cold running water and

restroom facilities, and board approved hospital grade sanitation products which are evident and in use;

I further certify that the information recorded hereon is correct to the best of my knowledge and belief.

_______________________________________________

Signature of school owner or school’s authorized agent

State of ______________, County of _________________________, ss.

Subscribed and sworn before me this ______ day of _______________________, 20 _____.

(seal)

_______________________________________________

Notary Public official signature

residing at ______________________________________

my commission expires ____________________________

BOL-SDP1-04/00

Application For Student Demonstrator Permit Form - State Board Of Cosmetology Bureau Of Occupational Licenses, State Of Idaho