State Form 47441 - Application For Approval Of Accountancy Continuing Education Course Sponsor - Indiana Professional Licensing Agency

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APPLICATION FOR APPROVAL OF ACCOUNTANCY
Indiana Professional Licensing Agency
302 W. Washington St., Rm. E034
CONTINUING EDUCATION COURSE SPONSOR
Indianapolis, IN 46204
State Form 47441 (6-96)
Telephone: (317) 232-2980
Approved by State Board of Accounts, 1996
Date of application (month, day, year)
FEE: $25.00
All fees are non-refundable and non-transferable.
Course outlines are not required with this application.
Name of sponsor
Name of contact person
Business address
Telephone number
(
)
I (we) hereby certify, under penalty of perjury, that the information submitted herewith is in compliance with the Indiana Board
of Accountancy Statutes and Rules, and is true and correct to the best of my (our) knowledge and belief.
Signature of applicant
Date signed (month, day, year)
Printed or typed name of applicant

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