Interior Designers - Application For Certification by Examination via NCIDQ

	State Of Maryland Department of Labor Maryland Board of Certified Interior Designers 1100 N. Eutaw St Baltimore, Maryland 21201 (410) 230-6322 (Baltimore area), (888) 218-5925 (Toll free)

Interior Designers - Application For Certification by Examination via NCIDQ

Name in full

LAST (NAME ON TRANSCRIPT IF DIFFERENT)

FIRST MIDDLE (IF YOU DO NOT HAVE A MIDDLE NAME, ENTER "N.M.N.")

Residence Address

STREET AND NUMBER

CITY COUNTY STATE ZIP CODE

EDUCATION

II. QUALIFICATIONS: Business Occupations and Professions Article §8-302 states, that to qualify for licensure, the applicant shall: "...have satisfied education and experience requirements necessary to qualify for the National Council of Interior Designers Qualification examination, or its equivalent, as determined by the Board; and have passed the National Council of Interior Designers Qualification examination, or its equivalent."

III. EXAMINATION: The Applicant must request that written verification of the passage of the NCIDQ examination, grades received and the date of passage be sent directly to the Board's office. A photocopy of the results sent to you will not be accepted. As your experience has been accepted by the NCIDQ to qualify for examination, you do not have to submit experience for the Board's review.

IV. APPLICATION REVIEW: Upon receipt of your application, transcript(s), verification from NCIDQ or verification of certification/licensure, your application will be submitted to the Maryland Board of Certified Interior Designers for review. You must assume all responsibility for the completeness and accuracy of your application.

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

Signature of Applicant

Date Signed

FOR OFFICE USE ONLY

APPROVED BY: DATE

1.
2.
3.
4.
5.

DENIED BY: DATE

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2.
3.
4.
5.

REASON FOR DENIAL:

Name in full
	LAST	(NAME ON TRANSCRIPT IF DIFFERENT)

	FIRST	MIDDLE (IF YOU DO NOT HAVE A MIDDLE NAME, ENTER "N.M.N.")

II.	QUALIFICATIONS: Business Occupations and Professions Article §8-302 states, that to qualify for licensure, the applicant shall: "...have satisfied education and experience requirements necessary to qualify for the National Council of Interior Designers Qualification examination, or its equivalent, as determined by the Board; and have passed the National Council of Interior Designers Qualification examination, or its equivalent."

III.	EXAMINATION: The Applicant must request that written verification of the passage of the NCIDQ examination, grades received and the date of passage be sent directly to the Board's office. A photocopy of the results sent to you will not be accepted. As your experience has been accepted by the NCIDQ to qualify for examination, you do not have to submit experience for the Board's review.
IV.	APPLICATION REVIEW: Upon receipt of your application, transcript(s), verification from NCIDQ or verification of certification/licensure, your application will be submitted to the Maryland Board of Certified Interior Designers for review. You must assume all responsibility for the completeness and accuracy of your application.

APPROVED BY:	DATE
1. 2. 3. 4. 5.

DENIED BY:	DATE
1. 2. 3. 4. 5.

REASON FOR DENIAL: