State Of Maryland Department of Labor, Licensing And Regulation
Maryland Board of Certified Interior Designers
500 N. Calvert St., Room 308
Baltimore, Maryland 21202
(410) 230-6322 (Baltimore area),    (888) 218-5925 (Toll free)

Interior Designers - Supplementary Application For Certification by Reciprocity

Name in full 
LAST  (NAME ON TRANSCRIPT IF DIFFERENT)

FIRST  MIDDLE (IF YOU DO NOT HAVE A MIDDLE NAME, ENTER "N.M.N.")
Home Address 
STREET AND NUMBER

CITYCOUNTYSTATEZIP CODE

Residence Telephone No.  
   Business Telephone No. 


EDUCATION

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."

VERIFICATION OF CERTIFICATION/LICENSURE: Send a Verification of Certification/Licensure form (available at the confirmation screen or CID Home Page) to the Board, which granted original certification/licensure, for completion. Include a stamped envelope, addressed to the Maryland Board of Certified Interior Designers. The verification form must be mailed directly from the original Board to the Maryland Board. It is suggested that you call the original Board to determine if a fee is charged to complete the verification.

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, Licensing and Regulation 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 


APPROVED BY: DATE
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DENIED BY: DATE
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REASON FOR DENIAL: