In State Form 15969 - Application For Examination For Cosmetologist, Manicurist And Shampoo Operator License Page 3

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PART G: MANICURIST TRANSCRIPT OF TRAINING (continued)

2. ACTUAL PRACTICE (In hours)

HOURS

Nail techniques

Manicuring

Pedicuring

Salesmanship

Total hours of actual practice

Signature of school official

PART I: SCHOOL CERTIFICATION

I do hereby certify and declare this transcript of training and the required Official Progress Book to be correct and accurate records of the progress of the

student enrolled at the school of cosmetology named below, and meets the requirements of the State Board of Cosmetology Examiners.

STATE OF

}

SS:

COUNTY OF

Subscribed and sworn to before me this ___________________ day of _________________________________ , ______________.

Signature of school official

Printed or typed name of school official

Signature of Notary Public

Printed or typed name of Notary Public

Notary county of residence

My commission expires: