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) |
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I. APPLICANT MUST COMPLETE THIS SECTION:
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(NAME OF APPLICANT) (STREET ADDRESS) (CITY) (STATE) (ZIP) Social Security No: _______________________ |
II. | THE BOARD OF PRIOR CERTIFICATION/LICENSURE MUST COMPLETE THIS SECTION: | ||||||||||||||||||||||||||||||
The above named person was certified/licensed as follows: | |||||||||||||||||||||||||||||||
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PLEASE COMPLETE ALL OF THE FOLLOWING INFORMATION:
EXAMINATION SUBJECT | NUMBER OF HOURS |
PASSING GRADE | DATE PASSED | NCIDQ EXAM |
BY: | (BOARD SEAL) |
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TYPE OR PRINT | ||
SIGNATURE | ||
TITLE: | ||
DATE: | ||