Form DBPR BAR8 "Application for Initial and Continuing Education Provider Approval" - Florida

Form DBPR BAR8 is a Florida Department of Business & Professional Regulation form also known as the "Application For Initial And Continuing Education Provider Approval". The latest edition of the form was released in May 29, 2012 and is available for digital filing.

Download a PDF version of the Form DBPR BAR8 down below or find it on Florida Department of Business & Professional Regulation Forms website.

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Download Form DBPR BAR8 "Application for Initial and Continuing Education Provider Approval" - Florida

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State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Application for Initial and Continuing Education Provider Approval
Form # DBPR BAR 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.
Initial and Continuing
Pay $250 fee. (Make check payable to the Department of Business and
Education Course
Professional Regulation.)
Provider
Please mail your completed application, documentation and required fee(s) 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 Barbering Initial and Continuing Education Course Provider
Application
a. To maintain provider status in good standing, providers must adhere to all provider
requirements outlined in Rule 61G3-16.0092, Florida Administrative Code, and Section
455.2178, Florida Statutes.
b. All portions of the application must be completed.
c. Fee: $250. (Make check payable to the Department of Business and Professional
Regulation.)
2. Application Instructions (by section)
a. Section I
i.
Check only one of the application types.
ii.
Initial and Continuing Education Provider - Individual
(1)
Select this application type if you are an individual applying to be an Initial and
Continuing Education Provider.
iii.
Initial and Continuing Education Provider - Organization
(1)
Select this application type if you are an organization applying to be an Initial and
Continuing Education Provider.
b. Section II
i.
Fill out each section completely.
ii.
In the “APPLICANT INFORMATION” area, individual applicants must use their name as it
appears on his or her Social Security card. Do not use nicknames or initials.
iii.
A Social Security number is required in order to apply for any individual license within the
Department of Business and Professional Regulation.
iv.
Businesses applying to be a provider must provide a Federal Identification number.
v.
If the applicant is an approved continuing education provider with another board within
the Department of Business and Professional Regulation, please indicate such and list
the provider approval number.
c. Section III
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
3. Other Information
a. Course providers shall not advertise a course as approved for continuing education credit
from the Florida Barbers’ Board until the course has been approved by the board and a
course number has been assigned.
DBPR BAR 8 Application for Continuing Education Provider
Incorporated by Rule: 61-35.006
May 29, 2012
1 of 4
State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Application for Initial and Continuing Education Provider Approval
Form # DBPR BAR 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.
Initial and Continuing
Pay $250 fee. (Make check payable to the Department of Business and
Education Course
Professional Regulation.)
Provider
Please mail your completed application, documentation and required fee(s) 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 Barbering Initial and Continuing Education Course Provider
Application
a. To maintain provider status in good standing, providers must adhere to all provider
requirements outlined in Rule 61G3-16.0092, Florida Administrative Code, and Section
455.2178, Florida Statutes.
b. All portions of the application must be completed.
c. Fee: $250. (Make check payable to the Department of Business and Professional
Regulation.)
2. Application Instructions (by section)
a. Section I
i.
Check only one of the application types.
ii.
Initial and Continuing Education Provider - Individual
(1)
Select this application type if you are an individual applying to be an Initial and
Continuing Education Provider.
iii.
Initial and Continuing Education Provider - Organization
(1)
Select this application type if you are an organization applying to be an Initial and
Continuing Education Provider.
b. Section II
i.
Fill out each section completely.
ii.
In the “APPLICANT INFORMATION” area, individual applicants must use their name as it
appears on his or her Social Security card. Do not use nicknames or initials.
iii.
A Social Security number is required in order to apply for any individual license within the
Department of Business and Professional Regulation.
iv.
Businesses applying to be a provider must provide a Federal Identification number.
v.
If the applicant is an approved continuing education provider with another board within
the Department of Business and Professional Regulation, please indicate such and list
the provider approval number.
c. Section III
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
3. Other Information
a. Course providers shall not advertise a course as approved for continuing education credit
from the Florida Barbers’ Board until the course has been approved by the board and a
course number has been assigned.
DBPR BAR 8 Application for Continuing Education Provider
Incorporated by Rule: 61-35.006
May 29, 2012
2 of 4
b. Approved course numbers and course titles should be used in all advertisements.
c. Any substantive changes regarding the provider’s application information must be filed with
the department within 30 days of the change.
d. Providers should supply a course completion certificate to all students upon completion of the
course whether the course be a pre-licensure course or a continuing education course.
e. Provider approval is valid until May 31 of odd-numbered years and must be renewed.
f.
Providers are responsible for renewing each course prior to the course expiration date.
g. Providers must work with licensees to resolve reporting conflicts.
h. If a course is approved for pre-licensure HIV/AIDS requirements, it is also approved for
continuing education credit.
Refer to Rules 61G3-16.009, 61G3-16.0091, and 61G3-16.0092, Florida Administrative Code, for
additional information regarding provider and course requirements.
DBPR BAR 8 Application for Continuing Education Provider
Incorporated by Rule: 61-35.006
May 29, 2012
3 of 4
State of Florida
Department of Business and Professional Regulation
Florida Barbers’ Board
Application for Initial and Continuing Education Provider Approval
Form # DBPR BAR 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 fees and additional information see the Instructions at the beginning of this application.
Section I – Application Type
CHECK ONE OF THE APPLICATION TYPES
 Initial and Continuing Education Provider - Individual [0306/1030]
 Initial and Continuing Education Provider - Organization [0306/1030]
Section II – Applicant Information
APPLICANT INFORMATION (Provider/Owner)
Last/Surname
First
Middle
Suffix
Company/Organization Name
Social Security Number (if applying as an Individual)*
Federal Employer ID Number (if applying as an Organization)
GENERAL IDENTIFICATION
Is provider approved by any other board within the Department of Business and Professional Regulation
to provide continuing education?
Yes
No
If yes, what is the provider approval number?
MAILING ADDRESS
Company Name
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
BUSINESS LOCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
DBPR BAR 8 Application for Continuing Education Provider
Incorporated by Rule: 61-35.006
May 29, 2012
4 of 4
Section II – Applicant Information- continued
CONTACT INFORMATION
Last Name (Authorized Representative) First
Middle
Title
Suffix
Primary Phone Number
Primary E-Mail Address
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.
Section III – 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 BAR 8 Application for Continuing Education Provider
Incorporated by Rule: 61-35.006
May 29, 2012
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