Form DBPR COSMO8 "Application for Registration of Initial HIV/AIDS Course" - Florida

What Is Form DBPR COSMO8?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR COSMO8 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR COSMO8 "Application for Registration of Initial HIV/AIDS Course" - Florida

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State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Registration of Initial HIV/AIDS COURSE
Form # DBPR COSMO 8
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Complete all sections of this application.
Submit a sample course completion certificate which shall
include the course title, provider name, student name, course
Initial HIV/AIDS Course
date, and total number of completed course hours.
Registration
Submit detailed course description.
Submit detailed course outline (please see section 1(d) of the
Instructions for more information).
Submit detailed course objectives.
Submit at least one complete copy of the course in its final form,
as it will be presented to the licensee, if approved (all course
pages should be numbered).
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0780
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. General Requirements for Registration of Initial HIV/AIDS Course
a. All portions of the application must be completed.
b. A sample course completion certificate must be submitted with the application. The
certificate must include the course title, provider name, student name, course date, and total
number of completed course hours.
c. Attach a course outline specifying subjects, major topics, and subtopics to be covered in the
course. Each subject must also include a narrative summary.
d. A detailed course description, outline, and objectives must be submitted with the application,
including source materials and the publication date(s) of the materials.
e. At least one complete copy of the course in its final form, as it will be presented to the
licensee, if approved, must be submitted (all course pages should be numbered).
f.
No fee is required.
2. General Information and Instructions
a. Section I
i.
Check only one course type.
b. Section II
i.
Fill out each section completely.
ii.
Each applicant must provide their name, company or organization name, and their
provider approval number.
c. Section III
i.
Input the title of the course in the space provided.
ii. All initial HIV/AIDS courses must cover the specified course requirements and must be at
least 4 hours in length.
iii. Indicate how the course will be provided to the student by checking the appropriate box.
d. Section IV
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation by written declaration statement, the
Department will not process the application.
DBPR COSMO 8 Application for Registration of Initial HIV/AIDS Course
Eff. Date: March 2021
Incorporated by Rule: 61-35.011
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State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Registration of Initial HIV/AIDS COURSE
Form # DBPR COSMO 8
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
Complete all sections of this application.
Submit a sample course completion certificate which shall
include the course title, provider name, student name, course
Initial HIV/AIDS Course
date, and total number of completed course hours.
Registration
Submit detailed course description.
Submit detailed course outline (please see section 1(d) of the
Instructions for more information).
Submit detailed course objectives.
Submit at least one complete copy of the course in its final form,
as it will be presented to the licensee, if approved (all course
pages should be numbered).
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0780
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1. General Requirements for Registration of Initial HIV/AIDS Course
a. All portions of the application must be completed.
b. A sample course completion certificate must be submitted with the application. The
certificate must include the course title, provider name, student name, course date, and total
number of completed course hours.
c. Attach a course outline specifying subjects, major topics, and subtopics to be covered in the
course. Each subject must also include a narrative summary.
d. A detailed course description, outline, and objectives must be submitted with the application,
including source materials and the publication date(s) of the materials.
e. At least one complete copy of the course in its final form, as it will be presented to the
licensee, if approved, must be submitted (all course pages should be numbered).
f.
No fee is required.
2. General Information and Instructions
a. Section I
i.
Check only one course type.
b. Section II
i.
Fill out each section completely.
ii.
Each applicant must provide their name, company or organization name, and their
provider approval number.
c. Section III
i.
Input the title of the course in the space provided.
ii. All initial HIV/AIDS courses must cover the specified course requirements and must be at
least 4 hours in length.
iii. Indicate how the course will be provided to the student by checking the appropriate box.
d. Section IV
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation by written declaration statement, the
Department will not process the application.
DBPR COSMO 8 Application for Registration of Initial HIV/AIDS Course
Eff. Date: March 2021
Incorporated by Rule: 61-35.011
2 of 4
3. Other Information
a. The course provider and application must be approved by the board before the provider can
administer the course to any student for credit.
b. All applications must be received at least sixty days in advance of a board meeting for
consideration by the board.
c. Providers should supply all students with a course completion certificate upon completion of
the course.
DBPR COSMO 8 Application for Registration of Initial HIV/AIDS Course
Eff. Date: March 2021
Incorporated by Rule: 61-35.011
3 of 4
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Registration of Initial HIV/AIDS Course
Form # DBPR COSMO 8
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Application Type
CHECK ONE OF THE APPLICATION TYPES
Initial HIV/AIDS Course [0517/1030]
Section II – Applicant Information- Provider
PROVIDER INFORMATION
Last/Surname (Provider)
First
Middle
Suffix
Company/Organization Name
Social Security Number (or FEID)*
Provider Approval Number (if applicable)
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Contact Name:
Primary Phone Number
Primary E-Mail Address
BUSINESS LOCATION ADDRESS
Street Address
City
State
Zip Code
County (if Florida address)
Country
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
.
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes
DBPR COSMO 8 Application for Registration of Initial HIV/AIDS Course
Eff. Date: March 2021
Incorporated by Rule: 61-35.011
4 of 4
Section III – Course Information
HIV/AIDS COURSE DATA
Course Title:
Subject Hours
HIV/AIDS
(see Rule 61G5-18.011, FAC, for course details)
Course Requirements:
● Modes of Transmission
● Infection Control Procedures
● Clinical Management
● Prevention
● Behavioral Attitudes
Method(s) of Instruction (check only one method):
 Live Study Group / Cosmetology Conference / Trade Show
 Distance/Online (Internet)
 Correspondence (Home Study / Video)
Section IV – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR COSMO 8 Application for Registration of Initial HIV/AIDS Course
Eff. Date: March 2021
Incorporated by Rule: 61-35.011
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