Mississippi State Board of Cosmetology
APPLICATION FOR RETAKE EXAMINATIONMississippi State Board of CosmetologyPost Office Box 55689Jackson, MS 39296-5689(601) 359-1820Please note that if over one year has lapsed since completion of your training, you may NOT be eligible for re-examination at this time. Please contact the Board office for information at (601) 359-1820.I hereby make application for retake examination for the following:(PLEASE SELECT ONLY ONE – ONE FORM PER REQUEST)THEORYCosmetologistEstheticianManicuristCosmotologist InstructorEsthetician InstructorManicurist InstructorPRACTICALCosmetologistEstheticianManicuristCosmotologist InstructorEsthetician InstructorManicurist InstructorCANDIDATE INFORMATIONNameAddressCity/State/ZipPhoneSocial Security NumberSchool NameSchool AddressLast Exam Date________________________________________________________________________SignatureDate ................
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