Form Bah - Apprentice Enrollment Application Form - Alaska Department Of Community And Economic Development Page 6

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STATE OF ALASKA
DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT
DIVISION OF OCCUPATIONAL LICENSING
BOARD OF BARBERS AND HAIRDRESSERS
P.O. BOX 110806
JUNEAU, ALASKA 99811-0806
(907) 465-2547
E-mail: license@dced.state.ak.us
LIST OF LICENSED PRACTITIONERS
(Use separate sheet of paper if necessary)
(One apprentice may be sponsored per every five licensed practitioners. 12 AAC 09.190(b)
NAME OF LICENSED PRACTITIONERS
LICENSE NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
NAME OF OTHER APPRENTICES CURRENTLY SPONSORED (if applicable)
1.
2.
3.
4.
5.
Shop Owner Signature
Instructor Signature
Date:
Date:
08-4194c (Rev. 6/00)

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