Architecture Form 2 - Certification Of Professional Education (Page 2 of 2) in pdf

Section II: Certification of Education

Instructions to Registrar: Please complete this form and sign the certifying statement. Attach an official transcript and return this form

directly to the Office of the Professions at the address at the end of this form. Do not return this form to the

applicant. This form will not be accepted if returned by the applicant.

Name of applicant: ____________________________________________________________________________________________

(Section I, item 5)

Date of applicant's entrance, date of completion of studies or withdrawal from the school:

Entrance date: _______ / _______ / _______

Completion/withdrawal date: _______ / _______ / _______

mo.

day

yr.

mo.

day

yr.

Degree awarded: ______________________________________________________ Date awarded: ________ / _______ / ________

mo.

day

yr.

Attach transcript, marksheets, or other record showing courses studied by year and passes (with grades if available) of all courses

taken at the time.

List any courses convalidated or accepted for transfer credit by your school. Give the basis on which these subjects were convalidated

and the name of the institution from which credit was transferred.

_____________________________________________________________________________________________________________

Certification

I hereby certify that to the best of my knowledge and belief the information in Section II is a true statement of the record of the

professional education of the individual named on this form.

Signature of Registrar or designee ________________________________________________ Date ________ / _______ / ________

mo.

day

yr.

Print or type name _____________________________________________________________

Title or official position __________________________________________________________

Institution ____________________________________________________________________

Institution

Address ____________________________________________________________________

Seal

_____________________________________________________________________

Telephone __________________________ Fax number ______________________________

E-mail _______________________________________________________________________

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services,

Architect Unit, 89 Washington Avenue, Albany, NY 12234-1000.

Architect Form 2, Page 2 of 2 (Rev. 10/08)

Architecture Form 2 - Certification Of Professional Education Page 2