The individual identified above has indicated that he/she either is or has been licensed in your jurisdiction or that he/she has completed examinations for your jurisdiction. Please complete the items listed below and record examination results this individual completed for your board on this form.

I certifiy that the records of the (State)   Board show that

Name and Address

1. Was licensed as an Architect on  19 
License No.

2. Now holds a valid license which expires on  19 
unless renewed 

3. Held a valid license which expired on
 

4. Was granted the above license:

a. By practice in the State at the time of Passage of Law
 

b. By NCARB Certification
 

c. By Reciprocity with the State of
 

d. By Exemption (indicate upon what basis candidate was registered)
    Education Training Oral Examination

e. By written examination of  hours,
completed in 

(Note: If the examination was not prepared by NCARB, please attach a sheet showing the following information: examination subject areas, hour duration, minimum passing grade and the grade received.)

5. Date of IDP completion 

6. NCARB uniform examinations were given and the reported grades were accecpted without modification.
   YES NO
7. Is there derogatory information on file with your Board regarding this applicant?   YES NO

If yes, please explain on an attached sheet.

EXAMINATION SYLLABUS (1954-1975)	Hours	Grade	Minimum Passing Grade	Date Passed
A. Education & Experience
B. Personal Audience
C. History & Theory of Architecture	3
D. Site Planning	5
E. Architecture Design	12
F. Building Construction	3
G. Structural Design	5
H. Professional Administration	3
I. Building Equipment	5

EQUIVALENCY EXAMINATION (June 1973 - June 1976)	Hours	Grade	Date Passed
I. Architectural Theory	2
II. Construction Theory & Practice	8
III. Architectural Design/Site Planning	10

QUALIFYING TEST (June 1977 - June 1982)	Hours	Grade	Date Passed
A. Architectural History	2
B. Structural Technology	3
C. Materials & Methods of Construction	2
D. Enviromental Control Systems	2
E.1 Principles of Site Planning & Arch. Design* (Multiple Choice)	1
E.2 Principles of Site Planning & Arch. Design (Design Problem)	11

  *1977-1978

PROFESSIONAL EXAMINATION-SECTION A (June 1979 - June 1982)	Hours	Grade	Date Passed
Design/Site Test	12

PROFESSIONAL EXAMINATION (December 1973 - December 1978) SECTION B (1979 - 1982)	Hours	Grade	Date Passed
Part I Environmental Analysis	4
Part II Architectural Planning	4
Part III Design and Technology	4
Part IV Construction	4

Architect Registration Examination - A.R.E. ( Beginning 1983 unless otherwise noted )	Grade	Date Passed
Division A Pre-Design
Division B Site Design (1983-1987)
Division B Site Design Written (1988-1996)
Graphic (1988-1996)
Site Planning (1997-Present)
Division C Building Design (1983-1996)
Building Planning (1991-Present)
Building Technology (1997-Present)
Division D Structural Technology - General (1983-1987)
Division D/F Structural Technology - General & Long Span (1988-Present)
Division E Structural Technology - Lateral Forces
Division F Structural Technology - Long Span (1983-1987)
Division G Mechanical, Plumbing, Electrical & Acoustical Systems
Division H Materials and Methods
Division I Construction Documents and Services

This document is certified by authorization of the   Board.

Certified by:  Title: 

Signature:  Date: