Form Cc1 - Application For School License March 2000 printable pdf download

Bureau of Occupational Licenses

IDAHO STATE BOARD OF COSMETOLOGY

1109 Main St., Suite 220

Boise, Idaho 83702-5642

(208) 334-3233

e-mail

dfoss@ibol.state.id.us

APPLICATION FOR SCHOOL LICENSE

_________________________________________________________________________________________________________

Name of School __________________________________________________________________________________________

School Location Address ___________________________________________________________________________________

street

city

state

zip

School Mailing Address____________________________________________________________________________________

street

city

state

zip

School Phone Number ______________________

Home Phone Number __________________

Name of School Owner(s)___________________________________________________________________________________

I hereby make application for a [ ] Barber School ($200.00 fee enclosed) or [ ] Cosmetology School ($500.00 fee enclosed)

license which will expire on either June 30 or December 31 of the year in which it is issued. Licenses will not be prorated for a

partial year.

Anticipated opening date_____________________

Has any Barber or Cosmetology school previously existed at this location?

[ ] YES

[ ] NO

If YES, give school name _______________________________________________, school license # _______________, and

owner's name____________________________________________________________________________________________.

If YES & the license is current, that license (marked "out of business" & signed by the previous owner), or a written statement

from the previous owner surrendering ownership, must be submitted with this application,

Does this application represent a change in location of your school?

[ ] YES

[ ] NO

If YES, give school name _______________________________________________, school license # _______________, and

former school address____________________________________________________________________________________.

A DETAILED CURRICULUM AND A COMPLETE LIST OF ALL INSTRUCTORS & STUDENTS MUST ACCOMPANY

THIS APPLICATION. A SCHOOL LICENSE SHALL BE ISSUED ONLY AFTER AN INSPECTION, CONDUCTED BY

THE BOARD OR IT’S AGENT, WHICH CONFIRMS THE SCHOOL’S COMPLIANCE WITH ALL LAWS & RULES.

AFFIDAVIT

I hereby certify that the above named school meets the licensure requirements as outlined by Idaho Laws & Rules.

I further certify that I am familiar with the city/county planning & zoning regulations governing the operation and maintenance of

a school and that I assume all responsibility for their compliance.

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

______________________________________________________

Signature of owner(s) or authorized agent(s)

State of ______________, County of _________________________, ss.

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

______________________________________________________

(seal)

Notary Public official signature

residing at _____________________________________________

my commission expires___________________________________

(SEE DIAGRAM INSTRUCTIONS)

BOL-CC1-03/00

Form Cc1 - Application For School License March 2000

Related Articles

Related forms

Related Categories