Mississippi State Board of Cosmetology



MS STATE BOARD OF COSMETOLOGYINITIAL LICENSURE APPLICATIONThis form must Be Completed and Accompanied by the Following Items:Score Sheet with Passing Grade (Theory and Practical)Check or money order for $50 for Cosmetologist, Manicurist & Esthetician LicenseCheck or money order for $70 for Master’s License Check or money order for $80 for Instructors License 2 Passport photos NAME:ADDRESS:SOCIAL SECURITY NUMBER:PHONE:TYPE OF LICENSE APPLYING FOR:COSMETOLOGISTESTHICIANMANICURISTMASTER COSMETOLOGIST MASTER ESTHETICIANMASTER MANICURISTCOSMETOLOGIST INSTRUCTORESTHETICS INSTRUCTORSMANICURING INSTRUCTORI CERTIFY UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.________________________________________________________________________________SignatureDateIf this form is incomplete, it cannot be processed and will be returned to you.MS State Board of CosmetologyPost Office Box 55689Jackson, MS 39296-5689Phone:601-359-1820 ................
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