Transcription of Application for Licensure
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- The University of the State of New York Department Use Only Professional engineering THE STATE EDUCATION DEPARTMENT Office of the Professions Form 1 Division of Professional Licensing Services Application for Licensure Applicants Must Complete All Four Pages Of This Application In Ink 1 Check what you are applying for: Eligibility for admission to Part A of exam: fundamentals of engineering , only16 $70 LX NYS License Number Licensure 16 $377 ER 2 Social Security Number(Leave this blank if you do not have a Social Security Number) Date Issued 3 Birth Date Month Day Year Initials 4 Print Name Exactly As You Wish It To Appear On Your License 6 Telephone/E-Mail Address Last Daytime Phone: Home or Busi
Check what you are applying for: Eligibility for admission to Part A of exam: Fundamentals of Engineering, only; 16
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