Form 08-4085b - Verification Of Registration And Examination
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1
2State 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
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. 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)
(SS#)
(Date of Birth)
THIS PORTION TO BE FILLED IN BY THE VERIFYING BOARD:
I. The above-named person was/is registered as:
Cert.
Date
Valid
Number
Issued
Until
Professional Engineer in
(list discipline)
Professional Land Surveyor
Professional Architect
II. Exam Verification
The above-named person passed the following examination(s):
NCEES:
1.
Written Examination:
Hours
Results
YES/NO
Exam Date
FE
Discipline:
PE
FLS
PLS
OTHER
NCARB A.R.E. Division:
OTHER (use back if needed):
2.
Oral Examination:
hrs
PE
hrs PLS
hrs A.R.E.
08-4085b (Rev. 11/00)
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