Cosmetic Laser Practitioner (Senior and Assistant)

o    HOW TO SUBMIT: Upload this document into the online account at the time of application submission.  If you have already submitted the application, this can be emailed to [email protected] with the applicant's name in the Subject Line.
o    Read this form in its entirety and complete all areas
o    A current passport photo is required to complete this form
o    Do not submit photos from digital reproductions, magazine, yearbook, wedding, birthday, family outing, etc.
o    Color copy best to ensure readable photo and notary
o    Photo has to recognizable
o    The applicant’s signature date and the notary signature date must match
o    No whiteouts or strikeouts are accepted
o    Form must be signed and notarized
o    Notary seal must be recognizable when scanned as a PDF
o    The Board will accept any notary stamp that complies with the laws of the jurisdiction in which it originates. For example, Georgia does not have a law allowing notaries to perform online notarization, so all Georgia notaries must perform services in-person.  However, some other states do allow online notarization (e.g. Virginia), so Georgia will accept remote stamps from other states where it is allowed.

o    HOW TO SUBMIT: Upload this document into the online account at the time of application submission.  If you have already submitted the application, this can be emailed to [email protected] with the applicant's name in the Subject Line.
o    The applicant’s signature date and the notary signature date must match
o    No whiteouts or strikeouts are accepted
o    Must be signed by applicant and notarized
o    Notary seal must be recognizable when scanned as a PDF
o    The Board will accept any notary stamp that complies with the laws of the jurisdiction in which it originates. For example, Georgia does not have a law allowing notaries to perform online notarization, so all Georgia notaries must perform services in-person.  However, some other states do allow online notarization (e.g. Virginia), so Georgia will accept remote stamps from other states where it is allowed.

o    HOW TO SUBMIT: Upload this document into the online account at the time of application submission.  If you have already submitted the application, this can be emailed to [email protected] with the applicant's name in the Subject Line.

US Citizens
o    Clear, legible copy of Driver’s license or Passport.  Only one document is required.
o    Please avoid use of Birth Certificates as they are required by law to be an original or certified copy of the original

Non-U.S. Citizens
o    Clear, Legible copy of qualified alien status documents, i.e.  Permanent Resident Card – front and back; SEVIS document; etc.
o    Please avoid copies of Driver’s license as this does not indicate your citizenship status in the U.S.
o    The Board participates in the DHS-USCIS SAVE (Systematic Alien Verification for Entitlements or "SAVE") program for the purpose of verifying citizenship and immigration status information of non-citizens
o    In order to confirm your status with the SAVE program, you need to provide the board with legible copies of one of the verifiable documents listed
o    If the following information is needed, it must be legible: Alien Number; Card Number; Document Expiration Date; SEVIS ID Number
o    One or all of these numbers or dates may be required when we submit your information to SAVE
o    If we cannot read what you have submitted, we will be unable to submit your information to the SAVE program, which will delay the consideration of your application

o    HOW TO SUBMIT: Upload this document into the online account at the time of application submission.  If you have already submitted the application, this can be emailed to [email protected] with the applicant's name in the Subject Line.
o    For SENIOR Cosmetic Laser Applicants ONLY
o    Complete the form in its entirety
o    Form must indicate at least three years of clinical /medical experience
o    Use multiple copies of the form to encompass all applicable information

o    HOW TO SUBMIT: Upload this document into the online account at the time of application submission.  If you have already submitted the application, this can be emailed to [email protected] with the applicant's name in the Subject Line.
o    For SENIOR Cosmetic Laser Applicants ONLY
o    Complete the form in its entirety
o    Must be signed by BOTH the Physician and the Applicant