Form 46221 - Request For Waiver Of Six Month Licensure Requirement July 1999

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INDIANA PROFESSIONAL LICENSING AGENCY

REQUEST FOR WAIVER OF SIX MONTH

Indiana State Board of Cosmetology Examiners

LICENSURE REQUIREMENT

302 West Washington Street, Room E034

State Form 46221 (R / 7-99)

Indianapolis, Indiana 46204

Telephone: 317-232-2980

INSTRUCTIONS: Please complete this form in it's entirety and return to the Indiana Professional Licensing Agency. Requests For Waiver Of Six Month Licensure

Requirement are reviewed monthly by the State Board of Cosmetology Examiners. Upon review, you will be notified in writing of the Board approval / denial.

REQUEST FOR WAIVER OF SIX MONTH LICENSURE REQUIREMENT (IC 25-8-7-3; IC 25-8-12.6-3, IC 25-8-7.1-3, IC 25-8-7.2-3)

On this ___________ day of ___________________________ , _______ , I, ___________________________________________________________ ,

Name

__________________________________________________________________________________________________________________________

Address

respectfully request the Board of Cosmetology Examiners to waive the requirement on holding a

cosmetologist license, or

manicurist license

esthetician license

electrologist license

for six (6) months prior to submitting my application for a

cosmetology salon license, or