Form DFS-N1-2036 "Application to Renew Funeral Director Internship to Continue Course of Study" - Florida

What Is Form DFS-N1-2036?

This is a legal form that was released by the Florida Department of Financial Services - 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 August 1, 2016;
  • The latest edition provided by the Florida Department of Financial Services;
  • 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 DFS-N1-2036 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.

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Download Form DFS-N1-2036 "Application to Renew Funeral Director Internship to Continue Course of Study" - Florida

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DEPARTMENT OF FINANCIAL SERVICES
Division of Funeral, Cemetery, and Consumer Services
200 East Gaines Street
Tallahassee, FL 32399-0361
Application to Renew Funeral Director Internship to Continue Course of Study
Under Section 497.375 (4)(b), Florida Statutes (F.S.). Before the Board of Funeral, Cemetery, and Consumer Services
REQUIRED FEE $ 105
(Attach check or money order payable to Department of Financial Services) (Nonrefundable)
This application form can only be used by interns who applied for and were granted internship under Section
497.375(1)(b)2., F.S., (they had not completed their required professional education at the time of internship application
and would be enrolled in a required course of study during internship). Issues relating to renewal of internship are
addressed at Section 497.375(4), F.S., and Rule 69K-18.002, F.A.C. That statute and rule are available on the Division’s
website at “http://www.myfloridacfo.com/division/funeralcemetery/.” As used in this application, “Division” refers to the
Division of Funeral, Cemetery, and Consumer Services, and “Board” refers to the Board of Funeral, Cemetery, and
Consumer Services.
SECTION 1. GENERAL INFORMATION
Intern’s full name as shown on intern license:
Intern license #:
Intern phone #: (
)
-
Intern mailing address:
Intern email address:
Name of training agency:
Training agency license #:
Address of training agency:
Phone # of training agency:
Name of Funeral Director in Charge
License # of FDIC:
(
)
-
(FDIC):
SECTION 2. INTERN CERTIFICATION
I, the intern named above, hereby apply for renewal of my funeral director internship. I certify that I am currently
enrolled in and attending the course of study identified in my application for internship.
____________________________________
__________________
Signature of FDIC
Date
SECTION 3. FDIC CERTIFICATION
I, the FDIC of the training agency where the above named intern is training, certify that I have been provided by the
intern and have reviewed a copy of the intern’s academic transcript issued by the college or university where the intern
is enrolled, and said transcript indicates that the intern has completed at least half the course work required for
completion of the course of study.
______________________________
______________
Signature of FDIC
Date
Mail completed application with all attachments and required fees to:
Division of Funeral, Cemetery, and Consumer Services
Revenue Processing
P.O. Box 6100
Tallahassee, FL 32314-6100
FOR DFS RECEIPTS OFFICE USE ONLY
BT
TYCL
FT
V
2303
F
$100
V
3800
F
$5
Page 1 of 1
DFS-N1-2036 (Rev. 08/16, Rule 69K-1.001, F.A.C.)
DEPARTMENT OF FINANCIAL SERVICES
Division of Funeral, Cemetery, and Consumer Services
200 East Gaines Street
Tallahassee, FL 32399-0361
Application to Renew Funeral Director Internship to Continue Course of Study
Under Section 497.375 (4)(b), Florida Statutes (F.S.). Before the Board of Funeral, Cemetery, and Consumer Services
REQUIRED FEE $ 105
(Attach check or money order payable to Department of Financial Services) (Nonrefundable)
This application form can only be used by interns who applied for and were granted internship under Section
497.375(1)(b)2., F.S., (they had not completed their required professional education at the time of internship application
and would be enrolled in a required course of study during internship). Issues relating to renewal of internship are
addressed at Section 497.375(4), F.S., and Rule 69K-18.002, F.A.C. That statute and rule are available on the Division’s
website at “http://www.myfloridacfo.com/division/funeralcemetery/.” As used in this application, “Division” refers to the
Division of Funeral, Cemetery, and Consumer Services, and “Board” refers to the Board of Funeral, Cemetery, and
Consumer Services.
SECTION 1. GENERAL INFORMATION
Intern’s full name as shown on intern license:
Intern license #:
Intern phone #: (
)
-
Intern mailing address:
Intern email address:
Name of training agency:
Training agency license #:
Address of training agency:
Phone # of training agency:
Name of Funeral Director in Charge
License # of FDIC:
(
)
-
(FDIC):
SECTION 2. INTERN CERTIFICATION
I, the intern named above, hereby apply for renewal of my funeral director internship. I certify that I am currently
enrolled in and attending the course of study identified in my application for internship.
____________________________________
__________________
Signature of FDIC
Date
SECTION 3. FDIC CERTIFICATION
I, the FDIC of the training agency where the above named intern is training, certify that I have been provided by the
intern and have reviewed a copy of the intern’s academic transcript issued by the college or university where the intern
is enrolled, and said transcript indicates that the intern has completed at least half the course work required for
completion of the course of study.
______________________________
______________
Signature of FDIC
Date
Mail completed application with all attachments and required fees to:
Division of Funeral, Cemetery, and Consumer Services
Revenue Processing
P.O. Box 6100
Tallahassee, FL 32314-6100
FOR DFS RECEIPTS OFFICE USE ONLY
BT
TYCL
FT
V
2303
F
$100
V
3800
F
$5
Page 1 of 1
DFS-N1-2036 (Rev. 08/16, Rule 69K-1.001, F.A.C.)