LETTER OF CERTIFICATION AND TRANSCRIPT OF HOURS REQUEST FORM INSTRUCTIONS
DOCUMENTS SUBMITTED WITH YOUR APPLICATION WILL NOT BE RETURNED. KEEP A COPY OF YOUR COMPLETED APPLICATION, ALL ATTACHMENTS AND YOUR CASHIER’S CHECK OR MONEY ORDER.
REQUEST - Check the box to indicate if you are requesting a letter of certification or a transcript of hours earned at cosmetology
school.
MAIL TO - Check the box to indicate where you want the letter of certification or transcript of hours mailed.
NAME - Write your name as it appears on your cosmetology license or student permit.
SOCIAL SECURITY NUMBER - Social security number disclosure is required by Section 231.302(c)(1) of the Texas Family Code in order to obtain a license. Your social security number is subject to disclosure to an agency author-ized to assist in the collection of child support payments. For more information regarding child support payments, contact the Texas Attorney General at:
www.texasattorneygeneral.gov/cs or call (512) 460-6000 or (800) 252-8014
5 LICENSE NUMBER(S) OR TDLR NUMBER - Write your cosmetology license number or TDLR number. This will help us locate your record.
6 OUT-OF-STATE COSMETOLOGY BOARD MAILING ADDRESS - Write the complete address for the out-of- statecosmetology board or other business where you want your letter of certification or transcript of hours mailed
7 MAILING ADDRESS - Write your current mailing address where you want your letter of certification or transcript of hours mailed.
8.PHONE NUMBER - Write a telephone number, including the area code, where we can reach you during the day. This may be your office phone number where we can leave a message.
9.EMAIL ADDDRESS - Write your email address only if you agree to the following statement:
By providing my email address I authorize the Texas Department of Licensing and Regulation (TDLR) to send licensing communications and required notices to me by electronic mail. I understand that I may revoke this authorization in writing and that I must update my email address or I will not receive these notices. I understand that the email address I have provided in this application will remain confidential except as permitted or required by law.
10.APPLICANT SIGNATURE - Date and sign your request form.
SEND YOUR COMPLETED APPLICATION AND REQUIRED DOCUMENTS TO:
Texas Department of Licensing and Regulation
P.O. Box 12157
Austin, TX 78711-2157
Documents submitted with your application will not be returned. Keep a copy of your completed application, all attachments, and your check or money order. Do not send cash.
For additional information and questions, please visit the Texas Department of Licensing & Regulation website at tdlr.texas.gov or reach Customer Service via web form. The web form will allow you to submit your request for assistance and include attachments needed at https://tdlr.texas.gov/help. You may also reach us at (800) 803-9202 [in state only], (512) 463-6599, Relay Texas-TDD: (800) 735-2989 or Fax: (512) 463-9468. Customer Service Representatives are available Monday through Friday 7:00 a.m. until 6:00 p.m. Central Time (excluding holidays).
LETTER OF CERTIFICATION AND TRANSCRIPT OF HOURS REQUEST
DO NOT WRITE ABOVE THIS LINE
LETTER OF CERTIFICATION FEE - $15 ⚫ TRANSCRIPT OF HOURS FEE - $5
(FEES ARE NON-REFUNDABLE)
PAYMENTS MUST BE IN THE FORM OF A CASHIER’S CHECK OR MONEY ORDER PAYABLE TO TDLR
ALL INFORMATION MUST BE TYPED OR PRINTED IN BLACK INK
|
1. Request: |
2. Mail to: |
|
Letter of Certification ($15) |
the out-of-state cosmetology board, cosmetology school, or other |
|
Transcript of Hours ($5) |
business written below in item 6 |
|
my personal mailing address written below in item 7 |
|
|
|
|
|
|
3. Name: |
|
_______________________________________________________________________________________________
Last, First, Middle Initial, Suffix (JR, SR, III)
4.Social Security Number: ______________________________________________________________________________________________
(See instruction sheet for disclosure information)
5. License Number(s): ___________________________ OR TDLR Number: ____________________________
6. Out-of-State Cosmetology Board Mailing Address: (PO Box is allowed for this address)
_______________________________________________________________________________________________________________________
Out-of-state Cosmetology Board or Out-of-state Cosmetology School
_______________________________________________________________________________________________________________________
Number, Street Name, Suite Number, City, State, Zip Code
7.Personal Mailing Address: (PO Box is allowed for this address)
_______________________________________________________________________________________________________________________________________________________________
Number, Street Name, Suite Number/Apartment Number, City, State, Zip Code
8. Phone Number: |
|
9. Email Address: |
___________________________________________________________________ |
_______________________________________________________________________________________ |
(Area Code) Phone Number |
|
(Ex: johndoe@gmail.com) See instruction sheet for disclosure information |
10. |
APPLICANT SIGNATURE |
I certify that I will comply with all applicable laws and rules related to my licensed occupation or profession. I further certify that all information I have provided is true and correct. I understand that providing false information may result in denial of this application and/or revocation of the license.
_________________ |
__________________________________________________________________ |
Date Signed |
Applicant Signature |
TDLR Form COS016 rev June 2019
