Architecture Form 2 - Certification Of Professional Education
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1
2The University of the State of New York
Architect
THE STATE EDUCATION DEPARTMENT
Office of the Professions
Form 2
Division of Professional Licensing Services
Certification of Professional Education
Applicant Instructions
Note: Complete this form ONLY if you were educated outside the United States or were licensed in another jurisdiction prior to September 1,
1999. For those licensed after September 1, 1999 transcripts will be included in the IDP record.
1.
Complete Section I in ink. In item 3, enter your name exactly as it appears on your Application for Licensure (Form 1). Be sure to sign
and date item 8.
2.
Send the entire form to the school where you completed your professional education and request that they complete Section II and
return this form directly to the Office of the Professions. This form will not be accepted if submitted by the applicant. Be sure to
include any fee required by the school. Keep a copy for your records.
Section I: Applicant Information
1.
1
Social Security Number
2.
2
Birth Date Month
Day
Year
(Leave this blank if you do not have a U.S. Social Security Number)
3
3.
Print Name As It Appears On Your Application for Licensure (Form 1)
Last
First
Middle
4
4.
Mailing Address
(You must notify the Department promptly of any address or name changes.)
Line 1
Line 2
Line 3
City
State
Zip Code
Country/
Province
5
5.
Print name under which degree/diploma was awarded (if different from above):
_____________________________________________________________________________________________________________
6
6.
Professional school attended: ____________________________________________________________________________________
Dates of attendance from: ________ / ________ / ________
to: ________ / ________ / ________
mo.
day
yr.
mo.
day
yr.
7
7.
Was degree/certificate/diploma awarded?
Yes
No
If yes, title: ______________________________________
_____________________________ Date _______ / _______ / _______
Field
mo.
day
yr.
8
8.
I request and give my permission to the school listed in item 6 above to provide any information requested, including information
requested on this form, to the New York State Education Department at the address at the end of this form.
_______________________________________________________________________________
________ / ________ / ________
Applicant’s Signature
mo.
day
yr.
Architect Form 2, Page 1 of 2 (Rev. 10/08)
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