Transcription of Application for Professional Engineer, Professional ...
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Application for Professional Engineer, Professional ...
Bureau of Professional Licensing PO Box 30670 Lansing, MI 48909 Telephone: (517) 241-9288 Professional ENGINEER, Professional SURVEYOR, ORARCHITECT RELICENSURE Application (This Form Should Not Be Used For License Renewal) Authority: 1980 PA 299, MCL Legal Name (First, Middle, Last)Date of Birth Social Security Number Address City State Zip Code Permanent Number Telephone Number E-Mail AddressI have the ability and will serve the public in a fair, honest and open manner. If I have had a judgment of guilt in a criminal proceeding or a civil action against me, I am rehabilitated or the substance of my former offense is not reasonably related to the occupation or profession for which I am seeking a license. Yes No Do you have any unsatisfied penalties or conditions imposed by disciplinary action in this state or any other jurisdiction? Yes No Applicants whose license has been expired for LESS than 3 yearsArchitect: Submit proof of not less than 24 hours of continuing education that was completed during the 2-year period immediately preceding the date of relicensure.
Title: Application for Professional Engineer, Professional Surveyor or Architect Reliensure or Reinstatement Author: jodi cornell Subject: design board relicensure form
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