MARYLAND - Prometric

Exam Application Form
for Maryland Barber and Master Barber Examinations
Complete all required sections. Incomplete or unsigned applications will be returned.
Mail the form with the appropriate fees and letter of eligibility to:
Prometric, Attn: MD Cosmetology Registration, 7941 Corporate Dr. Nottingham, MD 21236.
Section One – General Information
Last Name First Name Middle Name Suffix (“Jr.,” “III,” etc.)
Maiden Name/Former Surname (Attach legal documentation, i.e. marriage certificate)
Social Security Number
Residence Address (Your address of legal residence is required. ID and address must match.)
County City State ZIP Code
Date of Birth Sex Male Female Place of Birth (City , State and County)
Daytime Phone (including area code) Evening Phone (including area code) Email Address (applications without an
email address may experience delays)
Did you complete high school? Yes No If not, did you receive your GED? Yes No
If you did not complete high school or receive your GED, indicate last grade completed: 1 2 3 4 5 6 7 8 9 10 11
Indicate the name of the last high school, trade school, college or university you attended.
Dates attended:
From:
To:
Registration Number, Apprenticeship Number, or License Number if applicable (attach copy of license)
Have you ever been licensed for this profession in any other state? Yes No
If yes, indicate state registration number, type of license and year issued.
Have you taken this exam in the state of Maryland? Yes No
Have you been convicted of a felony? Yes No
I attest that the information contained in this form is true and accurate, to the best of my knowledge.
Candidate Signature:___________________________________________________
Date:________________
Section Two – Exam Selection and Fees
Barber exam
Exam Fee
Practical and Theory $80
Practical Only $50
Theory Only $50
Master Barber exam
Exam Fee
Theory Only $50
Payment: Fee may be paid by cashier’s check, money order, MasterCard or Visa, payable to Prometric. Please put your Social
Security number on the check. Personal checks and cash are not accepted. Fees are nonrefundable.
If paying by credit card, please complete the information on the last page.
When you have completed both sides of the exam application form, make a copy for your records and
mail the original form with the appropriate fees and letter of eligibility to:
Prometric
Attn: MD Barber Registration
7941 Corporate Drive
Nottingham, MD 21236
Fax: 800.347.9242 (Retakes only)
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