Looking for a Indiana Legal Forms And Templates? Download it for free!

State Form 45245 - Application For Examination For Cosmetology Esthetics, Or Electrology Instructor License - 2001 Page 3

PART G - TRANSCRIPT OF INSTRUCTOR TRAINING *

* Instructor training must be subsequent to active practice of cosmetology for at least six (6) months in a cosmetology salon;

active practice as an electrologist for at least one (1) year in a cosmetology or electrology salon; or active practice as an

esthetician for at least one (1) year in a cosmetology or esthetician salon.

Date of enrollment (month, day, year)

Date of completion (month, day, year)

Total Hours

Actual Practice Hours

Orientation and review of the pertinent curriculum

Orientation and review of the cosmetology curriculum

Introduction to teaching

Course outline and development

School administration

Assisting in the clinic and theory classrooms (Teaching)

Practice teaching in the clinic and theory classrooms

(Teaching)

TOTAL HOURS

TOTAL ACTUAL PRACTICE HOURS

Signature of school official

Date signed (month, day, year)

I do hereby certify and declare the transcript of training to be a correct and accurate record of the student enrolled at the school

of cosmetology named below, and meets the requirements of the State Board of Cosmetology Examiners.

Printed name of student

Signature of school official

Name of cosmetology school

Printed name of school official

STATE OF

}

SS:

COUNTY OF

Subscribed and sworn to before me, this __________ day of ______________________________, 20___________.

Signature of Notary Public

County of residence

Typed or printed name of Notary Public

Date commission expires

ATTACH A PHOTOGRAPH THAT IS AT LEAST

2” X 3” IN SIZE TO THE AREA BELOW.

State Form 45245 - Application For Examination For Cosmetology Esthetics, Or Electrology Instructor License - 2001 Page 3