DO NOT WRITE IN THIS SPACE

OFFICE RECORD

RECEIVED ______CARD ______

FEE_____ CK ( ) MO ( ) BD ( )

REG. NO. ______

CLK’s INITIALS ______

STATE OF MARYLAND

MARYLAND DEPARTMENT OF LABOR, LICENSING AND REGULATION

PROFESSIONAL LICENSING BOARDS

MARYLAND BOARD OF ARCHITECTS

ROOM 308 500 N. CALVERT STREET BALTIMORE, MARYLAND 21202-3651

410-230-6261

FAX (410) 962-8483

APPLICATION FOR ARCHITECTURAL LICENSING BY RECIPROCITY
FEE: $126.00, INCLUDES $50 NON-REFUNDABLE APPLICATION FEE AND $76.00 LICENSE FEE
MAKE CHECK PAYABLE TO DLLR-ARCH. DO NOT SEND CASH
1. To qualify for licensure by reciprocity in the State of Maryland, you must meet the requirements that were equivalent to those required by the laws of the State of Maryland. Qualifications are listed below.
2. QUALIFICATIONS
a. Prior to July 1, 1996, candidates for the exam must possess five education credits (earned either by possession of a degree from a NAAB accredited college, or by a combination of education and qualifying work experience) and three years of qualifying work experience, one year of which must have been in the offices of a registered architect.
b. After July 1, 1996 candidates must possess five education credits (see above) and complete the Intern development Program. If this section applies to you and you took the exam in a state that did not require IDP, you must document your IDP through NCARB before you can be granted a license by reciprocity in the State of Maryland.
SECTION I. individual information
Full Name
Last
First / Middle / (If you do not have a middle name enter “N.M.N.”)
Residence Address
Street and Number
City / County / State / ZIP Code
Email Address:
Residence Telephone No. / Business Telephone No.
Date of Birth / Place of Birth
MONTH / DAY / YEAR / City State / Country
Social Security No. / If you do not have one, contact the Board’s office.
Business Address
Street and Number
City / County / State / ZIP Code
Date of first examination
State of first registration / By Exemption / By Oral Exam / By Written Exam
Date of registration / Current registration no.
Have you ever been convicted of a felony, or of a misdemeanor in any State or Federal Court? NO YES
Have you ever had this type of license ever been denied, suspended or revoked by Maryland or any other State? NO YES
IF YOU ANSWERED “YES” TO ANY OF THE ABOVE QUESTIONS, PLEASE EXPLAIN ON AN ATTACHED SHEET.

SECTION II. ARCHITECT REFERENCES

In order that the Maryland State Board of Architects might have sufficient information to intelligently pass on your qualification, you must submit with your application, three (3) original letters of reference from architects who know your work. The letters should contain the following information, where applicable.

·  The business relationship to you.

·  The number of years architect has known you.

·  Whether or not the architect feels you possess adequate technical knowledge.

·  In the architect’s judgement, has your experience been of a satisfactory grade or character.

·  What is your reputation in the profession of architecture.

·  Further comments and recommendations.

·  Name of the state in which the architect is registered and registration number.

SECTION III. EXPERIENCE

Indicate kinds of work engaged in for each employer
and percentage of total time for each

Full Name and
Address of Employer
Designate if the office was that of a
Registered Architect (RA)
If the office was other than that of
a registered architect, state business / / / / / / / / / / / / / /
From
/ Years
/ Years
To
/ Months
/ Months
From
/ Years
/ Years
To
/ Months
/ Months
From
/ Years
/ Years
To
/ Months
/ Months
From
/ Years
/ Years
To
/ Months
/ Months
EXPLANATIONS: **If “other” kinds of work are noted, describe work.
*If part time work is noted, state average number of hours per week.

IF NEEDED, ATTACH ADDITIONAL SHEETS

SECTION IV. EDUCATION

TRANSCRIPTS: You shall furnish to the Board a complete official grade transcript (photocopies & “issued to student” transcripts not acceptable) from the architectural college attended showing completion of required work and grades achieved, degree, and date of award. (The Board is interested in advanced degree, but transcripts leading to a bachelor’s degree are most essential.)

Dates of / Type of Degree
Colleges, Universities, Technical Schools attended / Attendance / Conferred/Date
ADDRESS
ADDRESS
ADDRESS
Dates of / Type of Degree
Graduate work / Attendance / Conferred/Date
ADDRESS
ADDRESS
ADDRESS
SECTION V. Verification of Registration
Forward the enclosed “Verification of Registration” form to the State of your original registration. You should request the State Board to forward the verification directly to the Maryland Board. The Board will not act on your application until it receives this verification.
SECTION VI. CERTIFICATIONS
I do not operate a business that would require me to pay taxes and unemployment contributions to the Comptroller or the Department of Labor, Licensing and Regulation.
I certify that I do operate a business and that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor, Licensing and Regulation. or have provided for payment in a manner satisfactory to the unit responsible for collection.
I hereby certify that I have read and shall comply with all applicable rules and regulations governing the practice of architecture in the State of Maryland.
LICENSEE SIGNATURE / DATE
I AM NOT AN EMPLOYER REQUIRED TO PROVIDE EMPLOYEE COMPENSATION UNDER THE WORKERS’ COMPENSATION LAW.
I HAVE WORKERS’ COMPENSATION COVERAGE, POLICY/BINDER NO.
ISSUED BY
I understand that by signing this statement, the license for which I am applying will expire two years from the date of issue and that I will be required to renew this license and pay the renewal fee prior to the expiration date. I further understand that I may not engage in the occupation or profession for which I am applying until such time as a license has been issued to me.

“I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.” I further authorize the release of any information contained within this application to an authorized representative of the Department of Labor, Licensing and regulation for further investigation.

Signature of Applicant ______Date Signed ______

In accordance with Executive Order 01.01.1983-18, the Department of Labor, Licensing and Regulation is required to advise you as follows regarding the collection of personal information:

Personal information requested by the licensing agency of the Department is necessary in determining your eligibility for licensure. Such personal information is also intended for use as an additional means of verifying the licensee’s identity or to enable the agency to communicate, in a timely manner, with the licensee should the need arise. The licensee has a right to inspect his personal record and to amend or correct the personal data if necessary.

Personal information is generally available for inspection by the public only in accordance with the Public Information Act. Personal information is not routinely shared with state, federal or local governmental agencies.

YOU MUST ASSUME ALL RESPONSIBILITY FOR THE COMPLETENESS AND ACCURACY OF YOUR APPLICATION.

UPON RECEIPT OF YOUR COMPLETED APPLICATION, VERIFICATION OF PRIOR REGISTRATION, OFFICIAL COLLEGE TRANSCRIPT(S), AND THREE (3) REFERENCE LETTERS, YOUR APPLICATION WILL BE SUBMITTED TO THE MARYLAND STATE BOARD OF ARCHITECTS.

FOR OFFICE USE ONLY

APPROVED BY: / DATE:
1.
2.
3.
4.
DENIED BY: / DATE:
1.
2.
3.
4.
REASON FOR DENIAL:

DLLR/P/7/ARCH/(12-15)