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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