Cosmetology, Hair Design, Barber, Manicurist, Esthetician, Master ...
Cosmetology, Hair Design, Barber, Manicurist, Esthetician,
Master Esthetician, or Instructor
School Data Sheet
Submit information about your school, its curriculum, and any signees.
Online:
Or mail this completed form to: Cosmetology Program Department of Licensing PO Box 9026 Olympia, WA 98507-9026
For questions or language help call: (360) 664-6651
School information
PRINT or TYPE School name
Email
Business mailing address
City
State
ZIP code
Business street address
City
State
ZIP code
Days and hours of operation
UBI/UBI Business ID/UBI Location ID (16 digits)
(Area code) Business phone number
Business owner name (Last, First, Middle)
Manager name (Last, First, Middle)
Total number of hours required for course completion
Curriculum 1 Cosmetology Hair Design Barber
Manicurist Esthetician Master Esthetician Combined Master Esthetician Instructor
Curriculum 2 Cosmetology Hair Design Barber
Manicurist Esthetician Master Esthetician Combined Master Esthetician Instructor
Instructors authorized to sign?An instructor who is licensed in the curriculum and employed by the school
Last name
First name
Middle name
License number (if applicable) Expiration date Endorsement
I declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
TYPE or PRINT Name
X When you have completed this form, print it out and sign here.
Date and place
Business owner signature
Providing false information in this application may be cause for the denial, suspension, or revocation of your professional license in the state of Washington.
RCW 9A.72.085; 18.16; 18.235; 42.56
BC-638-078 (R/6/20)WA
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