
State and Consumer Services Agency – Governor Edmund G. Brown Jr
BOARD OF BARBERING AND COSMETOLOGY
P.O. Box 944226, Sacramento, CA 94244-2260
P (800) 952-5210 F (916) 575-7281 www.barbercosmo.ca.gov
PROOF OF TRAINING DOCUMENT
The Board of Barbering and Cosmetology requires verification of a student’s course of completion
in a California approved school of Barbering, Cosmetology or Electrology
Check one course of study
 BARBER
 COSMETOLOGY
 ELECTROLOGY
 MANICURE
 ESTHETICIAN
STUDENT INFORMATION
SOCIAL SECURITY NUMBER: _______________________________________BIRTHDATE: _______________________
FIRST NAME:________________________________ MIDDLE NAME: _________________ LAST NAME:______________________________
STREET ADDRESS: ___________________________________________________________________________________________________
CITY: ______________________________________________________________ STATE: _______ ZIP CODE: ________________________
TELEPHONE NUMBER: (_________)_______________________________________________________________
“I, the undersigned, certify under penalty of perjury under the laws of the State of California, that all the
information provided herein is true and correct.”
STUDENT’S SIGNATURE: _____________________________________________________ DATE: _______________
PRINT NAME OF SCHOOL REPRESENTATIVE: ____________________________________________________________________________
SIGNATURE OF SCHOOL REPRESENTATIVE: _______________________________________________________ DATE: _______________
TITLE OF SCHOOL REPRESENTATIVE: ___________________________________________________________________________________
SCHOOL INFORMATION
NAME OF SCHOOL: ______________________________________________
SCHOOL PHONE #: _______________________________
SCHOOL ADDRESS:_______________________________________________________________ SCHOOL CODE:_____________________
______________________________________________________________________________
TOTAL HOURS COMPLETED: ______________TOTAL HOURS COMPLETED AT CURRENT SCHOOL:_______________________________
DATE COURSE STARTED AT CURRENT SCHOOL: _________________________________________________________________
DATE TRAINING WAS COMPLETED AT CURRENT SCHOOL: ________________________________________________________
ADDITIONAL TRAINING
(RECEIVED AT ANOTHER CALIFORNIA BOARD APPROVED SCHOOL OF COSMETOLOGY OR BARBERING)
The Proof of Training Documents from each school attended MUST accompany the Proof of Training Document
NAME OF SCHOOL: _____________________________________________________________________________
SCHOOL CODE: _______________________________________
COURSE OF STUDY: _____________________________________________________________________________
DATE TRAINING STARTED: ______________________________ DATE TRAINING ENDED: ______________________________
COURSE TRANSFERS
(COURSE TRANSFERS MAY ONLY BE USED ONE TIME)
COURSE OF STUDY: _____________________________________________________________________________
DATE TRAINING STARTED: _______________________________________
LAST DATE OF ATTENDANCE: _______________________________________
HOURS EARNED: ______________________________ HOURS OF CREDIT: __________________________
LICENSE TYPE: _______________________________________
LICENSE NUMBER: ______________________________ EXPIRATION DATE: __________________________
SUPPLEMENTAL HOURS
OUT OF STATE OR OUT OF COUNTRY APPLICANTS MUST ATTACH THE LETTER FROM THE BOARD OF BARBERING AND
COSMETOLGY (REGARDING ADDITIONAL TRAINING REQUIRED) WITH THE PROOF OF TRAINING DOCUMENT.
SCHOOL SEAL HERE
Revised 2/10