Landscape Architects - Form 2A - Report of Professional Experience Continuation Sheet

	State of Maryland Department of Labor Maryland Board of Examiners of Landscape Architects 100 S. Charles St, Tower 1, 3rd Floor Baltimore, Maryland 21201 (410) 230-6322 (Baltimore area), (888) 218-5925 (Toll Free)

Landscape Architects - Form 2A - Report of Professional Experience Continuation Sheet

ENDORSER NUMBER
SHEET NUMBER	OF

Name:


Last	First	Middle

Social Security Number:

Signature:

Date of Birth:

/	/

	TIME YRS/MOS

Total this sheet
Total all sheets

SECTION IV: ENDORSER'S AFFIDAVIT: (COMPLETE ONE SIDE ONLY).

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.