Fillable Printable F Engineer-In-Training Short Form Registration Application

F Engineer-In-Training Short Form Registration Application

For validation only

Questions: call (360) 664-1575

Engineer-In-Training Short Form

Registration Application

You can use this form:

• IfyouhaveaforeigndegreethatisbeingevaluatedbyaBoard-approved

evaluatingservice,andtheevaluationdeterminesthedegreeisequivalent

toaB.S.degreefromaschoolintheU.S.

• Ifyouhaveanon-approvedengineeringdegree,anon-engineering

degree,oraforeigndegree,plusaMasterofSciencedegree(M.S.or

Ph.D.)inengineeringfromanapprovedprogram.

To apply for the Engineer-in-Training (EIT) exam:

• Sendthecompletedformto:

Board of Registration for Professional Engineers and Land Surveyors

Department of Licensing

PO Box 9025

Olympia, WA 98507

• Requestanofcialtranscriptbesentto:

Board of Registration for Professional Engineers and Land Surveyors

Department of Licensing

PO Box 9025

Olympia, WA 98507

Photocopiesarenotacceptable.

• Onceyouareapprovedfortheexam,youwillreceiveanemailwithinformationtoscheduleyourexam.

Applicant

PRINT or TYPE Name (Last, First, Middle – will appear in the proper order on your wall certiﬁcate) Maidenname (If any – will not appear on certiﬁcate)

SocialSecuritynumberrequired* Dateofbirth (mm/dd/yyyy) Gender

 Male Female

Mailingaddress

City State ZIPcode County

(Areacode)Businesstelephonenumber (Areacode)Residencetelephonenumber Email

Answerthefollowing

1. Hasanycourtorlicensingjurisdictiontakenactionagainstyouforyourpracticeinengineering

 orlandsurveying?.................................................................. Yes No

Ifyes,pleaseattachanexplanationonadditionalsheet.

2. Haveyoueverbeenconvictedoforenteredapleaofguiltyornolo contendretoamisdemeanor,

 grossmisdemeanor,orfelony? ........................................................ Yes No

Ifyes,pleaseattachanexplanationonadditionalsheet.

Nameandlocationofcollege,

university,technicalschoolattended

Datesofattendance

From To Curriculum Degree/Date

*AllapplicantsarerequiredbyfederalandstatelawtoprovidetheirSocialSecuritynumber(SSN)foruseinchildsupportenforcementprograms(42U.S.C.

666(a)(13)andRCW74.20A.320).Itmayalsobeusedforeducationloanrepaymentprogramsandidenticationofrecordswithsimilarnames.Submission

ofyourSSNismandatory;failuretosubmititmayresultindenialofyourapplication.

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Dateandplace Applicantsignature

We are committed to providing equal access to our services.

ENLS-651-018(R/7/15)WA If you need accommodation, please call (360) 664-1578 or TTY (360) 664-0116.

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