NCBA Online Candidate Record Review Application

Instructions

• You may only complete this application if the North Carolina Board of
  Architecture has directed you to do so and has received your completed AXP file
  from NCARB.
• Prior to completing this application you must read the Board rules and laws
  governing the practice of architecture in North Carolina, they are found at
   www.ncbarch.org in the rules and laws section.
• You are required to notify the Board of all contact information changes, including
  name changes. ALL correspondence from NCBA will be via email.

Name -

^*First:

Middle

^*Last

Suffix

^*Mailing Address 1

Address 2

^*City

^*State

^*Zip

^*Home Phone

Bus. Phone

Mobile

^*Email

^*SSN

^*Birth Date

^*Place of Birth

NCARB ID

I hereby apply for License Registration to practice architecture by exam.
I hereby certify that I have read the laws and rules governing the practice of architecture in North Carolina and that I will not willfully violate the statute or any rules or standard of conduct published by the North Carolina Board of Architecture.

I have never had a credential or license denied, limited, reprimanded, suspended, disciplined in any manner, or revoked.
I have never been convicted of a felony or misdemeanor under any laws.
There are no criminal charges pending against me.
I have not been found guilty of misconduct, unprofessional conduct, dishonest or fraudulent practice, or incompetent practice by any college/university, court, board, agency, or professional organization.
There are no charges pending against me before any court, board, agency, or professional organization for unprofessional conduct, dishonest or fraudulent practice or incompetent practice.

I certify that I have read and understand the Public Notice Statement required by NCGS 143-764(a)(5).
The Public Notice Statement is found at http://www.ic.nc.gov/121317ECSPublicNotice.pdf .
I certify that I have not been investigated for employee misclassification per NCGS 143-764(a)(5). Questions regarding employee misclassification should be directed to NC Industrial Commission at 919-807-2582

Under penalties prescribed by law, I hereby affirm to the best of my knowledge and
belief that the information contained in this form is true and complete.

Application to take the ARE

Registration Information

Instructions

CERTIFICATION

AFFIDAVIT