Form Bah - Apprentice Enrollment Application Form - Alaska Department Of Community And Economic Development

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BAH
FOR OFFICE USE ONLY
STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
BOARD OF BARBERS AND HAIRDRESSERS
333 WILLOUGHBY AVENUE, 9TH FLOOR
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-2547
E-mail: license@dced.state.ak.us
APPRENTICE ENROLLMENT APPLICATION FORM
Hairdresser
Barber
Esthetician
Initial Application (First Time Applying)
Reenrollment
Transfer From:
Total Number of Hours:
$50.00 Permit Fee
Student’s Full Name (PRINT):
Mailing Address:
Address
City
State
Zip Code
Telephone Number:
Sex:
M
F
Student’s Social Security Number:
Date of Birth:
Name of Shop Where You Wish to Apprentice:
Address:
City
State
Zip Code
Shop License Number:
Shop’s Telephone Number:
Name of Instructor Providing Training:
License Number:
Training Obtained Previously:
Place
Number of Hours
Place
Number of Hours
Date
Student Signature
NOTE:
A student who has interrupted his or her schooling for a continuous period of two years or more will not be
allowed credit for hours of instruction received prior to the date of interruption.
Transfer students from a state other than Alaska must submit a certified or notarized copy of their prior records.
A check or money order payable to the State of Alaska must be submitted with this application:
Student Permit Fee: $50.00 (12 AAC 02.140(3))
08-4194 (Rev. 6/00)

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