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)

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
CITY	COUNTY	STATE	ZIP CODE

Residence Telephone No.    Business Telephone No. 

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 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

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APPROVED BY:	DATE
1.  2.  3.  4.  5.
DENIED BY:	DATE
1.  2.  3.  4.  5.
REASON FOR DENIAL: