Form Bol-Arc-2-Endorsement - Application For Architect Licensure By Endorsement Page 2
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2STATE OF IDAHO
BUREAU OF OCCUPATIONAL LICENSES
APPLICATION FOR ARCHITECT LICENSURE BY ENDORSEMENT
(see instructions)
I hereby submit my qualifications and make application for an Architect license in the State of Idaho under the provisions of Title 54,
Chapter 3, Idaho Code as amended and provide the following:
1. Full Name (Mr., Mrs., or Ms.) _______________________________________________________________________________
2. Address of Record________________________________________________________________________________________
(The above address is public record)
Street/PO Box
City
State
Zip
3. Mailing Address__________________________________________________________________________________________
(The above address is not public record)
Street/PO Box
City
State
Zip
4. Date of Birth ______________ Place of Birth_______________________________ Social Security No. _______________
m
m-dd-yyyy
5. Business phone ________________
E-mail __________________________________
Fax _______________
(The above phone number is public record)
(The above fax number & e-mail is NOT public record)
6. Do you hold a National Council (NCARB) record (Green cover) or certificate? (Blue cover)
[ ]Yes
[ ]No
(If Yes, your NCARB record or certification must be received before your application will be processed & you may skip number 7
below. If No, continue to number 7.) 54-302A, I.C.
7. Are you a graduate of an accredited architectural curriculum & have 3 years architectural experience? [ ]Yes
[ ]No
(If Yes, this office must receive official educational transcripts directly from the university/college registrar AND documentation of 3
years experience. Verification letters from past employer are required to document experience.) 54-302, I.C. & Rule 300.01.
If No, you must submit satisfactory evidence that you have attained the educational equivalent, AND documentation of 8 years of
architectural experience. Verification letters from past employer are required to document experience.) 54-302, I.C.
8. Are you currently or have you ever been licensed in Idaho or any other state(s)?
[ ]Yes
[ ]No
(If Yes, we must receive certification of said licensure(s) directly from each issuing authority OR your NCARB certification
before your application will be processed.) 54-302A. I.C. List licensure states: _____________________________________
9. Have you ever had a license, certification, or registration revoked, suspended or otherwise sanctioned? [ ]Yes
[ ]No
(If yes, a copy of the charges and the final order must be received before your application will be processed.) 54-305. I.C.
10. Have you ever been convicted of any State or Federal felony or misdemeanor?
]Yes
[ ]No
(If yes, a detailed statement, a summary of the charges, the final order, any probation or parole documentation, and any other relevant
information must be received before your application will be processed.) 54-305.d I.C.
11. Have you solicited or practiced architecture or been self-represented as an architect in this state prior to this application?
(If Yes, please attach a supplemental explanation.) 54-305. & 54-310. I.C.
[ ]Yes
[ ]No
AFFIDAVIT
I hereby certify under oath that the responses provided above and those attached to this application are true and accurate to the best of
my knowledge and belief. I further certify that I have reviewed and will comply with the Idaho Laws and Rules governing the
practice of Architecture, and the National Council of Architectural Registration Boards' Rules of Conduct as adopted by the Idaho
Board. I also hereby authorize and direct any person, agency, firm, or other entity to release, upon the request of the Bureau of
Occupational Licenses or it’s authorized representative, any information, communication, report, record, statement, disclosure, or
recommendation that may have bearing on my eligibility for or maintenance of the license for which I am applying. I also hereby
authorize the Bureau of Occupational Licenses to release to any other regulatory entity in any jurisdiction any information requested
by about me that may otherwise be otherwise protected or confidential that may have bearing on my eligibility for or maintenance of
any license issued subsequent to this application.
____________________________________________________
Signature of applicant
State of ______________, County of _________________, ss.
Subscribed and sworn before me this ______ day of _______________________, 20 _____.
______________________________________________________
(seal)
Notary Public official signature
my commission expires___________________________________
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BOL-ARC-2-ENDORSEMENT - revised 07/09
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