January 27, 2004 - Louisiana Board of Cosmetology



MICRODERMABRASION APPLICATION PERMIT

NAME _____________________________________________ SSN ___________________________

ADDRESS __________________________________________ DOB ___________________________

_____________________________________________________________________________

A licensed Esthetician must submit:

1. a microdermabrasion permit application,

2. a copy of their current esthetics license,

3. satisfactory evidence of completion of a training course on the operation of microdermabrasion equipment to be used.

A licensed Cosmetologist (who was initially licensed prior to April 1, 2003) must submit:

1. a microdermabrasion permit application,

2. a copy of their current cosmetology license,

3. satisfactory evidence of completion of a training course on the operation of the microdermabrasion equipment used.

4. one of the following:

A. completion of at least 200 hours of study in esthetics,

B. evidence if practicing esthetics for a period of at least one year,

we accept the following

i. copies of W-2’s or 1099’s prior to April of 2003 and a sworn (notarized) statement by the issuer indicating that the individual worked the equivalent of 25 hours per week for at least 48 weeks during a periods of one year; or

ii. copies of income tax returns, if self employed, and sworn (notarized)statements from at least 5 clients indicating that esthetic services were performed on them by the applicant.

A licensed Cosmetologist (who was initially licensed after April 1, 2003) must submit:

1. a microdermabrasion permit application,

2. a copy of their current cosmetology license,

3. satisfactory evident of completion of a training course on the operation of the microdermabrasion equipment to be used,

completion of at least 200 hours of study in esthetics.

_________________________________________________ ________________________

Applicant Signature Date

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