NCBARID Licensure by Exam Application

Instructions

• Rules and laws are available on the Board’s website at www.ncbarch.org.
• You are required to notify the Board of all contact information changes. All correspondence from the Board
  will be via email.
• Upon approval of your license, notification will be sent to your email address on this application.
• The Board asks questions about an applicant’s criminal, disciplinary and employment history to assist the Board
  in determining if the application should be granted, or if there is a valid basis for denying an application.
   In addition to the questions on the applications, the Board may conduct a formal criminal or disciplinary history check.
   Please contact the Board if you have any criminal conviction.

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

As a sole proprietor or an employee of a sole proprietorship.

The firm name is

(refer to rule 21 NCAC 02.0205)

As an employee, principle, officer, director or shareholder of a corporate entity.

The firm name is

(refer to rule 21 NCAC 02.0214 for NC corporations or 21 NCAC 02.0215 for out of state corporations and G.S. 83A-8*)

As an employee, principle, member, manager or owner of a limited liability company.

The firm name is

(refer to rule 21 NCAC 02.0218 and G.S. 83A-8*)

As an employee or partner of a limited liability partnership.

The firm name is

(refer to rules 21 NCAC 02 .0204, .0205)

Other—Please describe in detail

*An individual cannot hold himself out as offering architectural services for a corporation or LLC not
registered to practice architecture in North Carolina. In cases of violation of General Statute 83A-8,
the Board will prosecute the individual unless the employing corporation is licensed and registered in
the State for architectural services. If a corporation or company (PA, PC, Inc, LLC, PLLC, etc.) employs
you, please contact this office or our web site for the necessary forms to begin the firm registration
process.

I hereby certify that I have read the laws and rules governing the practice of architecture
in North Carolina and that I shall not violate the statute or any rules or standard of conduct
published by the North Carolina Board of Architecture and Registered Interior Designers.

I have never had a credential or license/registration 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 court, board, agency, college, university 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
foregoing statements are made in good faith and are true in every respect.

Application for Architect License by Exam

Fee: $55

Instructions

Practice

CERTIFICATION

AFFIDAVIT