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 3 - Verification of Licensure


I: APPLICANT MUST COMPLETE THIS SECTION (TYPE)
TO:
STATE BOARD
NAME OF APPLICANT
STREET ADDRESS
CITY STREET ZIP
SOCIAL SECURITY NUMBER

SECTIONS II - V FOR COMPLETION BY BOARD OF PRIOR LICENSURE

II. THE ABOVE NAMED PERSON WAS LICENSED AS A LANDSCAPE ARCHITECT:



NUMBER ISSUED DATE ISSUED VALID UNTIL DATE APPLIED


III. MINIMUM REQUIREMENTS WERE:

PLEASE COMPLETE ALL OF THE FOLLOWING INFORMATION

EXAMINATION SUBJECT NUMBER
OF HOURS
PASSING GRADE DATE PASSED CLARB EXAM?
 1.  Oral Examination  Written Examination
2.  The above license was granted by reciprocity with the State of 
3.  OTHER: Please give full details on page 2 of this form.
IV.  PLEASE USE PAGE 2 OF THIS FORM FOR FURTHER EXPLANATION OR COMMENTS.
V.  INDIVIDUAL HAS BEEN THE SUBJECT OF DISCIPLINARY ACTION BY THIS BOARD. PLEASE INCLUDE COPY OF FINAL ORDER IN THE MATTER.
BY:  
       (BOARD SEAL)
TITLE:
DATE:
NOTE TO APPLICANTS: Include a postage paid, addressed envelope for return to Maryland Board