Individuals

Surveyor Intern Certificate Application

General Information

Please complete all sections of the application.

Applicant Details


Passport Sized Recent Head and Shoulder Photo 2 x 2 inches (51 x 51 mm)


Board records, wall certificate and your seal will reflect first name, middle initial and last name unless another preference is indicated below.

Physical Residence Address

Physical Business Address

Mailing Address

Same as

Experience

http://www.ncbels.org/wp-content/uploads/2019/06/SI-Evidence-of-Experience-Form.pdf
Upload evidence of experience in PDF format below.

Education Information

University/College/School Name:
Date of Graduation:
Degree Conferred - (Civil, Surveying, Electrical, etc.)

References

References: Three individuals who are familiar with the applicant's work, character and reputation, one of which must be a Professional Land Surveryor.
Reference forms must be mailed directly to the NC Board office in sealed envelopes with the reference's signature across the back flap.
Name PE/PLS Licensed State

Exam

Background

  1. Have you previously applied for certification as an SI in North Carolina?
  2. Have you previously applied for certification as an SI or licensure in any other state and been denied?
    You must upload details in PDF format below.
  3. Have you ever been disciplined on any professional license?
    You must upload details in PDF format below.
  4. Have you ever been convicted of a felony?
    You must upload proof of restoration of civil rights in PDF format below.
  5. Have you ever been convicted of a misdemeanor? (Do not include traffic violations.)
    You must upload details in PDF format below.
  6. Are you a U.S. citizen?
    Provide detailed explanation of legal status in PDF format below.
  7. Does NCEES have an official verified transcript from your educational institution?
    The applicant must have the educational institution send an official transcript to the Board either by mail or e-mail (dtaylor@ncbels.org).



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