Form 08-4398c - Verification Of Registration And Examination For Landscape Architects
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1State of Alaska
Department of Community and Economic Development
Division of Occupational Licensing
Board of Registration for Architects, Engineers and Land Surveyors
333 Willoughby Avenue
P.O. Box 110806, Juneau, Alaska 99811-0806
Telephone: (907) 465-2540
E-mail: license@dced.state.ak.us
VERIFICATION OF REGISTRATION AND EXAMINATION FOR LANDSCAPE ARCHITECTS
APPLICANT: REGISTRATION BOARDS REQUIRE THAT YOU INCLUDE A STAMPED, ADDRESSED ENVELOPE WITH
THIS VERIFICATION, WHICH MUST BE COMPLETED BY THE STATE ISSUING ORIGINAL REGISTRATION
AND RETURNED DIRECTLY TO THE ALASKA BOARD AT THE ADDRESS GIVEN ABOVE. CONTACT THE
STATE BOARD OFFICE TO DETERMINE IF VERIFICATION FEES ARE REQUIRED PRIOR TO BOARD
COMPLETION. TOP PORTION TO BE FILLED IN BY THE APPLICANT:
NAME AND MAILING ADDRESS OF BOARD
SUBMITTING THIS VERIFICATION
(Applicant Name)
(Mailing Address)
(City)
(State)
(ZIP Code)
(Telephone Number)
(Social Security Number)
(Date of Birth)
THIS PORTION TO BE FILLED IN BY THE VERIFYING BOARD:
I.
The above-named person was / is registered as a Professional Landscape Architect:
Certificate Number:
Date Issued:
Expiration Date:
II.
He / She was granted the above registration:
(a) by practice in the State at time of passage of Law
(b) by reciprocity with the State of
(c)
by oral examination
hours
(d) by written examination
hours
(e) Other
The written examination was completed on
The oral examination was completed on
III.
PLEASE COMPLETE ALL THE FOLLOWING INFORMATION:
Uniform CLARB Exam
Exam Subject
Number of Hours
Passing Grade
Date Passed
(Yes or No)
IV.
Has any disciplinary action been taken on this license?
Yes
No
(If yes, please explain on
reverse side, or attach copies of action as applicable.)
V.
Remarks:
BY:
TITLE:
(BOARD SEAL)
STATE:
DATE:
PLEASE RETURN THIS FORM DIRECTLY TO THE DIVISION
08-4398c (Rev. 12/00)
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