Transcription of Application for Licensure
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Application for Licensure
- 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 Business First Area Code Phone NumberMiddle E-Mail Address (Please print clearly): Lic
6 Telephone/E-Mail Address Area Code Phone Number ... (8 NYCRR §59.4) limit the issuance of professional licenses, registrations ... BE DIRECTED TO THE U.S. CITIZENSHIP AND IMMIGRATION SERVICES (USCIS) BY CALLING 1-800-375-5283, OR VISIT THEIR WEB SITE AT WWW.USCIS.GOV.
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