Form DBPR COSMO 8 Application for Initial Course Registration of Hair Wrapper, Hair Braider, Body Wrapper and Initial Hiv/Aids - Florida

Form DBPR COSMO8 is a Florida Department of Business & Professional Regulation form also known as the "Application For Initial Course Registration Of Hair Wrapper, Hair Braider, Body Wrapper And Initial Hiv/aids". The latest edition of the form was released in September 1, 2013 and is available for digital filing.

Download a PDF version of the Form DBPR COSMO8 down below or find it on Florida Department of Business & Professional Regulation Forms website.

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State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Initial Course Registration of Hair Wrapper, Hair Braider, Body Wrapper and Initial
HIV/AIDS
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
date, and total number of completed course hours.
Initial Course 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.
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 Initial Course Registration for Hair Wrapper, Hair Braider, Body
Wrapper, and Initial HIV/AIDS
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.
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.
Check only one course type. If an applicant desires to register more than one course
please fill out an additional application for each course.
(1)
For hair braiding, hair wrapping, and body wrapping courses, ensure that the course
covers the specified course requirements and subject hours.
DBPR COSMO 8 Application for Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September
1 of 5
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Initial Course Registration of Hair Wrapper, Hair Braider, Body Wrapper and Initial
HIV/AIDS
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
date, and total number of completed course hours.
Initial Course 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.
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 Initial Course Registration for Hair Wrapper, Hair Braider, Body
Wrapper, and Initial HIV/AIDS
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.
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.
Check only one course type. If an applicant desires to register more than one course
please fill out an additional application for each course.
(1)
For hair braiding, hair wrapping, and body wrapping courses, ensure that the course
covers the specified course requirements and subject hours.
DBPR COSMO 8 Application for Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September
2 of 5
(a) All hair braiding courses must be a minimum of 16 hours, and must contain the
subjects outlined in the application. All subjects must conform to the number of
subject hours displayed in the application.
(b) All hair wrapping courses must be a minimum of 6 hours, and must contain the
subjects outlined in the application. All subjects must conform to the number of
subject hours displayed in the application.
(c) All body wrapping courses must be a minimum of 12 hours, and must contain the
subjects outlined in the application. All subjects must conform to the number of
subject hours displayed in the application.
(2)
All 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.
3. Other Information
a. Hair braiding, hair wrapping and body wrapping course providers are only required to
complete this application package and are not required to complete any other provider
application, nor are there any fees due with the application.
b. The course provider and application must be approved by the board before the provider can
administer the course to any student for credit.
c. All applications must be received at least sixty days in advance of a board meeting for
consideration by the board.
d. Providers should supply all students with a course completion certificate upon completion of
the course.
DBPR COSMO 8 Application for Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September
3 of 5
State of Florida
Department of Business and Professional Regulation
Board of Cosmetology
Application for Initial Course Registration of Hair Wrapper, Hair Braider, Body Wrapper and Initial
HIV/AIDS
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
Hair Braiding Course [0515/1030]
Body Wrapping Course [0516/1030]
Hair Wrapping Course [0514/1030]
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 Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September
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Section III – Course Information
COURSE DATA
Course Title:
Subject Area (please check the appropriate course type for which you are
Subject Hours
applying):
(see Rule 61G5-31.004, FAC, for course details)
Hair Braiding
Course Requirements:
● Initial HIV/AIDS Course
5
● Sanitation Sterilization
5
● Diseases and Disorders of the Scalp
4
● Laws and Rules
2
(see Rule 61G5-31.004, FAC, for course details)
Hair Wrapping
Course Requirements:
● Initial HIV/AIDS Course
2
● Sanitation Sterilization
2
● Diseases and Disorders of the Scalp
1
● Laws and Rules
1
(see Rule 61G5-31.004, FAC, for course details)
Body Wrapping
Course Requirements:
● Initial HIV/AIDS Course
3
● Sanitation Sterilization
4
● Diseases and Disorders of the Skin
4
● Laws and Rules
1
Method(s) of Instruction (check only one method):
 Live Study Group / Cosmetology Conference / Trade Show
 Distance/Online (Internet)
 Correspondence (Home Study / Video)
HIV/AIDS COURSE DATA
Course Title:
Subject Hours
(see Rule 61G5-18.011, FAC, for course details)
HIV/AIDS
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)
DBPR COSMO 8 Application for Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September
5 of 5
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 Initial Course Registration
Incorporated by Rule: 61-35.011
2013 September

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