Fillable Application for Renewal of a School License (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Application for Renewal of a School License (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
New Jersey State Board of Cosmetology and Hairstyling
124 Halsey Street, 6th Floor, P.O. Box 45003
Newark, New Jersey 07101
(973) 504-6400
Application for Renewal of a School License
The fee for the biennial renewal of a school license is $ _______________. All licenses expire on July 31
th
. A money order or
certied check must accompany the application. A school license is not transferrable.
Pursuant to the provisions of Title 45:5B of the Revised Statutes of the State of New Jersey, the undersigned hereby applies for a
renewed license to conduct a School of Cosmetology and Hairstyling.
Ownership
a. Name of school: __________________________________________________________________________________________
Address:
School telephone number: ( ) ______________________________________ (include area code)
b. Ownership information: (Check one) Individual Partnership Corporation
Name of principal __________________________________ Address
Name of principal __________________________________ Address
Name of principal __________________________________ Address
Administration
a. List the name(s) and title(s) of the person(s) responsible for directing/operating the school.
Director/Administrator Title
Name: ________________________________________________ __________________________________________________
Name: ________________________________________________ __________________________________________________
Name: ________________________________________________ __________________________________________________
List the days and the hours when classes are in session.
Mondayhours Tuesdayhours Wednesdayhours Thursdayhours Fridayhours Saturdayhours
Day
Evening
b. Is the school accredited? Yes No
c. Accrediting agency: _______________________________________________________________________________________
Address:
Telephone number: ( ) ____________________________________ (include area code)
Building Information
Owned Leased If “Leased,” provide expiration date of lease: _________________________________________
Insurance
List the names of the liability and worker’s compensation insurance companies, the policy numbers and the amount of coverage
currently in effect.
Insurancecompany Policynumber Amountofcoverage
List the name of the performance bond insurance company, the policy number and expiration date, and the amount of coverage
currently in effect.
Insurancecompany Policynumber Expirationdate Amountofcoverage
Certication
I/we hereby certify that the statements made herein are true to the best of my/our knowledge and belief, and are made for the
purpose of inducing the New Jersey State Board of Cosmetology and Hairstyling to issue a renewed school license. If granted,
I/we agree to comply with the laws and rules and regulations of the Board.
Signature of owner(s) or ofcer if incorporated:
Name ________________________________________________ Name _______________________________________________
State of _____________________________County of ________________________________
Sworn and subscribed to before me this _______ day of _____________________ , 20 _____ .
____________________________________ _____________________________________
Name of Notary Public (please print) Signature of Notary Public
Note: The following documents are to be submitted in support of this application.
a. A copy of your most recent nancial statement.
b. Enrollment data for preceding 24-month period (form attached).
c. Current catalog or bulletin.
d. Current enrollment agreement.
e. Samples of all advertising and promotional materials currently in use (yellow pages, newspapers, direct mail, etc.).
f. Copies of the reports of any re and/or health inspections conducted during the preceding 24-month period. If violations
occurred during that period, you must verify that they have been corrected.
g. Copies of liability and worker’s compensation policies.
h. Copy of school bond.
i. List of staff currently employed including current license/student registration numbers for supervisors, instructors and student
instructors.
Afxsealhere
Revised11/09
New Jersey Ofce of the Attorney General
DivisionofConsumerAffairs
NewJerseyStateBoardofCosmetologyandHairstyling
Enrollment for the 24-month period from _____ / _____ , 20_____ to _____ / _____ , 20_____
Schoolname:_________________________________________________________________________________
Report each course by “Day and Evening” or “Full-time and Part-time” separately.
Do not include students who cancelled within the grace/cooling-off period.
M=MaleF=FemaleT=Total
Carry-over New Numberof
No.of Tuition fromprevious enrollments Still graduates
clock Include Allother Total report thisperiod Graduates Drop-outs attending placed
Coursetitle hours reg.fee fees cost M F T M F T M F T M F T M F T M F T
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Application for Renewal of a School License (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 14 August 2020

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