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State Form 45303 - Application For Examination For Barber Instructor Registration - Indiana Professional Licensing Agency Page 2

CERTIFICATE OF TRAINING

THIS SECTION TO BE COMPLETED BY THE BARBER SCHOOL ON BEHALF OF THE EXAMINATION APPLICANT

(Disregard this section if applying under the experience equivalent)

I hereby certify that

has completed nine hundred (900) hours of instructor training and

(name of applicant)

has graduated from the

School of Barbering.

(name of school)

Signature of school Director/Instructor:

Printed name of school Director/Instructor:

NOTARY CERTIFICATE

STATE OF:

COUNTY OF:

, have been duly sworn on oath, say that I am the above named school Director/

(name of School Director/Instructor)

Instructor, that I have personally prepared the foregoing certificate of training, and that the same is true to the best of my knowledge and belief.

Signature of School Director/Instructor:

Printed or typed name of School Director/Instructor:

Signature of Notary Public:

Printed or typed name of Notary Public:

Date commission expires:

Date subscribed and sworn to Notary Public:

AFFIX RECENT PHOTOGRAPH HERE

State Form 45303 - Application For Examination For Barber Instructor Registration - Indiana Professional Licensing Agency Page 2