State of Maryland Department of Labor, Licensing and Regulation
Maryland Board of Examiners of Landscape Architects
500 N. Calvert St., Room 308
Baltimore, Maryland 21202
(410) 230-6322 (Baltimore area),    (888) 218-5925 (Toll Free)

Landscape Architects - Form 2 - Report of Professional Experience

ENDORSER
NUMBER
SHEET
NUMBER
  OF 


INSTRUCTIONS TO APPLICANT: After reading the instructions, complete Sections I and Section III, make a copy for your own records, and forward this original RPE form to your endorser. Be sure the endorser number in the box provided corresponds with the appropriate endorser number and information on FORM 1. SECTION I AND III MUST BE TYPED.
SECTION I: TO BE COMPLETED BY APPLICANT. (This Section Must Be Typed).
Name: 
LAST FIRST MIDDLE
Address: 
STREET CITY STATE ZIP


Telephone: (home)       (work)      


Social Security Number:       Date of Birth: 
/ /

Experience described on the second page of this RPE form was obtained while employed by:
Firm or Organization Name: 
Address: 
Beginning:  and Ending:   checkboxFull time  checkboxPart time,  hrs/wk

I hereby certify that the work experience described on page 2 of this RPE form and the time claimed for that experience are true and accurate.
Applicant's Signature Date
SECTION II: TO BE COMPLETED BY ENDORSER  (Preferably not in the presence of applicant. Please Type.)
INSTRUCTIONS TO ENDORSER:

1. Read carefully the applicant's Report of Professional Experience on the second page of this RPE form and continuation sheets (if any).

2. Provide the requested information below and answer questions 1-6. Please type.

3. If you disagree with any information presented by the applicant on this form, or wish to provide any other information for consideration by the Board relative to the applicant, please submit a separate letter with this form. If you do so, please identify applicant by full name and social security number in your letter and indicate that they are an applicant for landscape architect licensure.

4. SIGN THE ENDORSER'S AFFIDAVIT IN SECTION IV ON THE SECOND PAGE AT THE BOTTOM OF EACH CONTINUATION SHEET(FORM 2A), IF ANY, or if you do not sign the affidavit please explain in a separate letter attached to this form.

5. DO NOT RETURN ORIGINAL TO APPLICANT. MAIL COMPLETED FORM DIRECTLY TO THE BOARD AT THE ADDRESS ABOVE.
Endorser Name:  Phone No:  
Address: 
Street City State Zip
Are you a licensed Landscape Architect?  checkbox YES  checkbox NO
STATE LICENSE NO.
WITH RESPECT TO THE APPLICANT'S REPORT OF PROFESSIONAL EXPERIENCE AS DESCRIBED ON THE SECOND PAGE OF THIS FORM:
1. Does that description accurately reflect the work personally preformed by the applicant?
 
checkbox YES  checkbox NO
2. Does the time claimed by the applicant for this experience reasonably reflect the actual time?
 
checkbox YES  checkbox NO
3. Was the applicant's work performed in an adequate, reliable and professional manner?
 
checkbox YES  checkbox NO
4. Are you attaching a separate letter with additional information about the applicant?
 
checkbox YES  checkbox NO
5. IDENTIFY YOUR WORK RELATIONSHIP TO THE APPLICANT AT THE TIME. IF NONE, EXPLAIN.
6. Comments: 


SECTION III: TO BE COMPLETED BY APPLICANT.(This section must be typed.)
A. Describe your Landscape Architecture duties during your employment with the firm named on the first page of the RPE:






B. Describe in separate paragraphs the specfic Landscape Architecture work you personally performed while employed by the firm named on the first page of this RPE. Use specific project assignments as examples. Then indicate separately in the TIME column at the right the time you spent on each such kind of work. If you need more than one endorser from a single form, USE SEPARATE RPE FORMS FOR EACH ENDORSER. If you do not have sufficient space on this form to fully report the experience to be verified by a single endorser, use one or more RPE Continuation sheet (Form 2A). BOTH YOU AND YOUR ENDORSER MUST SIGN EVERY SHEET.
  TIME
YRS/MOS
Total this sheet
Indicate here the number of RPE CONTINUATION SHEETS (Form 2A) for this endorser. If zero, enter "0".  checkbox
C. Describe briefly your personal level of responsibility or authority for work described above. Explain here any changes in your title resulting from promotions or other job changes during this period of employment.






SECTION IV: ENDORSER'S AFFIDAVIT: (ALSO COMPLETE SECTION II ON FIRST PAGE).
I have read the applicant's Report of Professional Experience. I hereby certify that I am knowledgeable about, and qualified to attest to, the applicant's work and Landscape Architecture ability and that , except as otherwise noted on this form, or in attached correspondence, the work experience described by the applicant and the time claimed therefore are generally true and accurate.


ENDORSER'S SIGNATURE
SEAL
DATE
 I cannot so certify. Letter of explanation attached.