NCBA Online Reciprocity Application

Instructions

• You must have a valid NCARB Certification to use this form.
• After review and approval by the Executive Director, you will receive an email stating your North Carolina
  License number. The North Carolina Board of Architecture does not issue temporary licenses for use
  during processing time and the applicant may not offer or render architectural services in the
  State until the Board issues a proper license.
• The Board directs the applicant’s attention to the rules and laws governing the practice of
  architecture in North Carolina: General Statute 83A and 21 NCAC 02, both are available on
  the board web site www.ncbarch.org in the Rules/Laws section.
• You are required to notify the Board of all contact information 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

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*)
*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.

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

I hereby apply for License Registration to practice architecture by reciprocity with NCARB.
My NCARB Certificate is current and in good standing. I understand that revocation
of the NCARB certificate by NCARB shall automatically terminate my license to practice in
North Carolina until such time as the certificate is reinstated by NCARB.

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 laws or any rules or standard of conduct
published by the North Carolina Board of Architecture.

I hereby certify that I have not offered or rendered architectural services as defined in G.S. 83A.

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 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
foregoing statements are made in good faith and are true in every respect.

Application for Architect License by Reciprocity

Fee: $155

Instructions

Practice

CERTIFICATION

AFFIDAVIT