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KANSAS BOARD OF COSMETOLOGY 714 S.W. Jackson Suite 100 Topeka Kansas 66603 www. kansas. gov/kboc 785 296-3155 FELONY CONVICTION DISCLOSURE FORM APPLICATION TYPE COSMETOLOGY BODY ART Apprentice Practitioner Renewal Establishment Instructor APPLICANT/LICENSEE INFORMATION NAME HOME ADDRESS PHONE Trainer EMAIL CITY STATE CELL PHONE DATE OF BIRTH CASE INFORMATION Attach additional sheets if you need to list more cases COURT NAME CASE NO. I understand providing false information may constitute...
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