Intern Application :

Application for Licensure


What type of license are you applying for?	Engineer Intern	Land Surveyor Intern

Personal Information


First Name	Middle Name	Last Name	Suffix(if applicable)
Social Security Number	Date of Birth	Place of Birth	Maiden Name (if Applicable)

Contact Information


Mailing Address
City	State	Zip Code
Phone Number	Email Address


Do you wish to receive email notifications in lieu of mailing in regards to your license?	Yes	No

Password

The board uses a password to login into the personal dashboard and if you save this application you will need this to log back into the form.

Please create your password below.

Passwords must be at least 8 (eight) characters in length and include at least 1 (one) uppercase letter, lowercase letter, number and special character.
Special characters allowed are ! $ % & * ( ) - [ ] { } , / : ?


Password:	Confirm Password:

Questions


Have you ever applied for, or been granted, licensure in North Dakota?	Yes	No
Please provide details:
Do you have an ABET accredited degree?	Yes	No


I passed the Fundamentals of Engineering examination on:	I passed the Fundamentals of Land Surveying examination on:
State Passed In:

Education

List in chronological order all college(s), university(s), or technical school(s) you received a degree from.

You will need to request official transcripts be sent to the NDPELS office at
3255 Greensboro Dr, Ste 203
Bismarck, ND 58503-1357


Name of Institution	Location	From	To	Degree Received	Date Graduated