DO NOT WRITE IN THIS SPACE OFFICE RECORD DATE RECEIVED ________ FEE$_________CK( ) MO( ) BD( ) APPLICATION NO._____________ CLK’S INITIALS________________ R FORM R-1 STATE OF MARYLAND DEPARTMENT OF LABOR, LICENSING AND REGULATION STATE BOARD FOR PROFESSIONAL ENGINEERS 500 N. CALVERT STREET, ROOM 308, BALTIMORE, MD. 21202-3651 pe@.dllr.state.md.us APPLICATION FOR PROFESSIONAL ENGINEER LICENSURE BY RECIPROCITY FEE : $126.00 FEE INCLUDES: $76.00 LICENSE FEE + $50 NON-REFUNDABLEAPPLICATION FEE. Application is filed under the subsection checked: (see directions) 14-305(b) 14-305(c) 14-305(d) 1. PERSONAL DATA: Name: LAST FIRST MIDDLE or Indicate (NONE) LAST NAME ON TRANSCRIPT, IF DIFFERENT Address: (Street) (Apt., Suite No.) (City) (State) (ZIP) (non-US Country) Telephone: Day Evening Social Security Number E-Mail If not US Citizen: INS# A (Required By State Law) Date of Birth Place of Birth Have you passed the (EIT) Fundamentals Examination? YES NO State Date If no, file under 14-305 (d) ONLY Do you hold an unexpired license as a professional engineer? License No. If YES, State NCEES RECORD being submitted? YES YES NO Expiration Date NO 2. CONDUCT QUESTIONS: All Questions MUST be answered. a. b. c. d. Has licensure ever been denied? YES NO Suspended? YES NO Revoked? YES NO If YES, explain on a separate 8 1/2 x 11 sheet. (typed) Have you ever been convicted of a felony or misdemeanor directly related to the fitness and qualification of an applicant or licensee to practice engineering in any State or Federal court? YES NO Have you ever been found guilty of misconduct, incompetence, or gross negligence while practicing engineering in any jurisdiction? YES NO Have you been convicted of or received probation before judgment of any drug offense committed after January 1, 1991? YES NO If you answered YES to any question(s) a-d, submit a letter giving complete explanation and a true test copy of the applicable court document(s). Also, notify the appropriate state licensing board to send a copy of the final order in your case directly to the Maryland Board. I am not an employer required to provide employee compensation under the Workers' Compensation Law. OR I have workers' compensation coverage, policy/binder No. Issued by (Co Name) Page 1 of 2 Form R-1 DLLR/PL/ENG/R1 (12-13) 3. EDUCATION Name of College or University Degree Graduation Date Name of College or University Degree Graduation Date check if additional information attached NOTE: An official academic transcript must be sent to the Board's office directly from the college registrar if no NCEES record is submitted, or if applying under 14-305(d). Transcripts marked “issud to student” will not be accepted. Foreign Degree applicants: See page 3 of the instructions. 4 REFERENCES. Signatures are required below of not fewer than five citizens unrelated to applicant, at least three of whom must be professional engineers, with license number/State listed. REFERENCES OF CHARACTER - "This certifies that I have been personally acquainted with the applicant; and that I believe the applicant to be of good character and repute." Date Signature Name (printed) Address City, St, Zip License No./State PE PE PE 5. CERTIFICATION I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I further authorize the release of any information contained within this agreement to an authorized representative of the Department of Labor, Licensing and Regulation for further investigation. I certify that I have paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Department of Labor, Licensing and Regulation or have provided for payment in a manner satisfactory to the unit responsible for collection. 6. I AFFIRM THAT I HAVE CAREFULLY READ THE LAW AND REGULATIONS SET FORTH IN TITLE 14, BUSINESS OCCUPATIONS AND PROFESSIONS ARTICLE, ANNOTATED CODE OF MARYLAND, AND THE CODE OF MARYLAND REGULATIONS, TITLE 09, SUBTITLE 23. I FURTHER AFFIRM THAT I UNDERSTAND AND ACCEPT MY RESPONSIBILITIES UNDER SUCH LAWS AND REGULATIONS. Signature of Applicant______________________________________________________DATE ___________________ In accordance with Executive Order 01.01.1983-18, the Department of Labor, Licensing and Regulation is required to advise you as follows regarding the collecting of personal information: Personal Information requested by the licensing agency of the Department is necessary in determining your eligibility for licensure. Such personal information is also intended for use as an additional means of verifying the licensee's identity or to enable the agency to communicate, in a timely manner, with the licensee should the need arise. The licensee has a right to inspect his/her personal record and to amend or correct the personal data if necessary. Personal information is generally available for inspection by the public only in accordance with the Public Information Act. Personal information is not routinely shared with state, federal or local government agencies. Page 2 of 2 Form R-1 DLLR/PL/ENG/R1 (12-13) R FORM R- 3 REQUEST FOR VERIFICATION OF LICENSURE Maryland State Board for Professional Engineers 500 N. Calvert Street . Room 308 . Baltimore, Maryland 21202-3651 1-888-218-5925 or (410) 230-6322 • FAX: (410) 333-0021 APPLICANTS: INCLUDE POSTAGE PAID, ADDRESSED ENVELOPE WHEN FORWARDING TO ANOTHER STATE BOARD FOR RETURN TO ABOVE ADDRESS BOARD OF PRIOR LICENSURE PERSONAL DATA FROM: STATE BOARD (NAME OF APPLICANT) ADDRESS (STREET ADDRESS) (CITY) (STATE) (ZIP) Social Security No. STATE VERIFICATION INFORMATION [to be completed by State Board, Not by Applicant] LICENSE DATE THE ABOVE NAMED PERSON LICENSED: NUMBER ISSUED PROFESSIONAL ENGINEER VALID UNTIL ENGINEER-IN-TRAINING (passed FE) BASIS OF LICENSURE 1. WRITTEN EXAMINATION : HOURS RESULTS (PASS/FAIL/GRADE) NCEES EXAM EXAM DATE (MO-DAY-YR) FE (EIT) _______ ________ YES NO _________ P&P (PE) _______ ________ YES NO _________ YES NO _________ STATE SPECIFIC/OTHER _______ ________ EXAMINATION OPTION (DISCIPLINE)______________________________ 2. ORAL EXAMINATION PE________ Hours 3. BY COMITY: FE (EIT) ACCEPTED FROM: P&P (PE) ACCEPTED FROM: 4. FE_______ Hours _______________ (State) _______________ (State) OTHER________________________________________________________________________________ EDUCATION AND EXPERIENCE: Were your state's requirements equal to or more demanding at the time this person was licensed than Marylands which, from June 1, 1967 to present, have been: YES NO EDUCATION None Non-accredited 4 yr engineering degree EAC/ABET accredited degree EXPERIENCE 12 years, of which 5 were in responsible charge 8 years 4 years IF Applicant was licensed prior to June, 1967, list requirements in effect at the time on the reverse side of form., or attach, and check DISCIPLINARY QUESTIONS 1. Has any disciplinary action ever been taken against the applicant? 2. If so, has this disciplinary case been satisfied to the Board's requirements? YES YES NO NO If not, please note on back BY:___________________________________ Date:_____________ TITLE:_________________________________ BOARD SEAL Page 1 of 1 -Form R- 3 DLLR/PL/ENG/R1 (12-13) Form 4 R STATE BOARD FOR PROFESSIONAL ENGINEERS ENGINEERING CURRICULUM CHECKLIST CANDIDATES APPLYING UNDER TITLE 14-305(c) NON-EAC/ABET APPROVED CURRICULUM AND ALL FOREIGN DEGREE APPLICANTS (SEE PAGE 3 OF THE DIRECTIONS) MUST COMPLETE THE FOLLOWING COURSE OUTLINE CHART. THIS FORM MUST BE TYPED, or clearly printed. NOTE: You are advised to review Regulation .09.23.05.05 to determine courses which are not allowed. See instructions. Last Name First Middle A. LIST COLLEGES/UNIVERSITIES ATTENDED: DEGREE DATE RECEIVED 1. 2. 3. AN ENGINEERING CURRICULUM OF 4 SCHOLASTIC YEARS OR MORE FROM A COLLEGE OR UNIVERSITY WHERE THE CURRICULUM CONSISTED OF AT LEAST: B. 15 semester credit hours in MATHEMATICS, which shall include differential calculus, integral calculus, and differential equations: College # (above) COURSE NAME COURSE COURSE CONTENT/DESCRIPTION CREDIT HOURS SEMESTER NUMBER QTR TOTAL C. 15 semester credit hours in BASIC SCIENCES, including general chemistry and general physics with calculus: C/U# COURSE NAME COURSE COURSE CONTENT/DESCRIPTION SEMESTER NUMBER TOTAL Page 1 of 2 - RE Form 4 DLLR/PL/ENG/R1 (12-13) CREDIT HOURS QTR D. 30 semester credit hours in ENGINEERING subjects that (1) Include a course, project, or thesis that focuses upon engineering design (indicate with a *) (2) Incorporate hands on quantitative laboratory work correlated with the science and design instruction (indicate with **) (3) For graduation subsequent to 1975, at least one high level computer language such as FORTRAN or PASCAL, C/C++, or MATLAB so that the student is able to compose computer programs to solve problems in science and design (indicate with ***) (4) demonstrate familiarity with probability, statistics, and linear algebra (indicate with ****) Engineering courses shall be selected subject areas such as: Biochemistry, Biophysics & Biometrics Computer Science Electrical, Electronic & Computer Engineering engineering Design Finite Element Analysis Geochemistry & Geophysics Physical, Organic & Inorganic Chemistry Transient Analysis & Feedback Control Solid State Physics, Nuclear Physics, Quantum Optics Strength of Materials C/U# COURSE NAME COURSE Civil & Structural Engineering Digital Signals & Systems Electrodynamics Engineering Economics Fluid Mechanics, Hydraulics, & Gas Dynamics Materials Science Sanitary & Environmental Engineering Transfer & Transport Phenomena Statistics and Dynamics Thermodynamics COURSE CONTENT/DESCRIPTION CREDIT HOURS SEMESTER NUMBER QTR TOTAL E. 15 semester credit hours in advanced courses in mathematics, science or engineering. C/U# COURSE NAME COURSE COURSE CONTENT/DESCRIPTION CREDIT HOURS SEMESTER NUMBER TOTAL THIS FORM MUST BE RETURNED COMPLETED WITH YOUR APPLICATION Page 2 of 2 - RE Form 4 DLLR/PL/ENG/R1 (12-13) QTR R Form 5 STATE OF MARYLAND DEPARTMENT OF LABOR, LICENSING AND REGULATION STATE BOARD FOR PROFESSIONAL ENGINEERS RECORD OF EXPERIENCE RECIPROCITY APPLICANT ONLY FULL NAME LAST FIRST MIDDLE Enter earliest employment first. Engagement Number Date Mo. Engineering Experience Claimed Employment Record Yr. (a) Name, Complete Location and Character of Business (b) TYPE of applicant’s Engineering Work (c) Degree of Responsibility Time Years Name and complete Address of Person familiar with Each Position In Months From: 1 To: From: 2 To: From: 3 To: From: 4 To: TOTAL TIME DLLR/PL/ENG/R1 (12-13) PAGE OF R Form 5 Page 2 STATE OF MARYLAND DEPARTMENT OF LABOR, LICENSING AND REGULATION STATE BOARD FOR PROFESSIONAL ENGINEERS RECORD OF EXPERIENCE FULL NAME LAST FIRST MIDDLE Enter earliest employment first. Engagement Number Date Mo. Yr. Employment Record Engineering Experience Claimed (a) Name, Complete Location and Character of Business (b) TYPE of applicant’s Engineering Work (c) Degree of Responsibility Time Years Name and complete Address of Person familiar with Each Position In Months From: To: From: To: From: To: From: To: TOTAL THIS SHEET TOTAL ALL SHEETS DLLR/PL/ENG/R1 (12-13) PAGE OF APPLICATION FOR PROFESSIONAL ENGINEER LICENSURE BY RECIPROCITY The Maryland Board for Professional Engineers 500 N. Calvert Street, Room 308, Baltimore, MD 21202 410-230-6322 fax 410-333-0021 pe@dllr.state.md.us PROFESSIONAL ENGINEER LICENSING IN MARYLAND Professional Engineer licensing in the State of Maryland is under the administration of the Department of Labor, Licensing and Regulation, under the jurisdiction of the Board for Professional Engineers which consists of seven members appointed by the Governor. The Board authorizes the practice of professional engineering in several ways: Licensure by Examination in Maryland: after meeting the Board’s education and/or experience requirements, and the successful completion of all parts of a written examination in the Principles and Practice of Engineering, the Board may issue an original license to practice as a professional engineer. Reciprocity: The Board may accept current licensure in another state or territory provided that the requirements for licensure in that state, or territory are equivalent to those required by the Board. REQUIREMENTS FOR PROFESSIONAL ENGINEER LICENSURE BY RECIPROCITY QUALIFY An applicant may qualify for licensure by reciprocity who: 1. is licensed to practice Professional Engineering in another state or territory of the United States; and 2. provides adequate evidence that, at the time the applicant was licensed by the other state or territory, the applicant met requirements that were equivalent to those then required by the laws of Maryland; or 3. provides adequate evidence that, at the time of application for a license by reciprocity, the applicant meets the requirements currently required by Maryland. THERE ARE THREE OPTIONS UNDER WHICH TO APPLY: § 14-305. (b) APPROVED CURRICULUM OPTION [ Note: Accredited 4-year Degree, pass FE Exam, 4 years Experience, Pass PE exam] (1) (2) An applicant qualifies under this section if the applicant: (i) has been graduated from a college or university on completion of at least a 4-year curriculum in engineering, or its equivalent, that the Board approves; (ii) subject to paragraph (2) of this subsection, has at least 4 years of work experience in engineering that is satisfactory to the Board and that indicates to the Board that the applicant may be competent to practice engineering; (iii) has passed an 8-hour written examination in the fundamentals of engineering given by the Board under this subtitle; and (iv) after passing the examination in fundamentals, has passed an 8-hour written examination in the principles and practice of engineering given by the Board under this subtitle. If an applicant has completed graduate study in engineering that is satisfactory to the Board, it may allow the applicant up to a 1-year credit toward the experience requirement of paragraph (1)(ii) of this subsection. OR Instructions Page 1 of 6 DLLR/PL/ENG/R1 (12-13) § 14-305. (c) UN-APPROVED CURRICULUM OPTION [Note: non-accredited (non-EAC/ABET approved curriculum or a foreign degree) 4-year Degree, pass FE Exam, 8 years Experience, Pass PE exam] An applicant qualifies under this section if the applicant: (1) has been graduated from a college or university on completion of at least a 4-year curriculum in engineering, or its equivalent, that the Board has not approved; (2) has at least 8 years of work experience in engineering that is satisfactory to the Board and that indicates to the Board that the applicant may be competent to practice engineering; (3) has passed an 8-hour written examination in the fundamentals of engineering given by the Board under this subtitle; and (4) after passing the examination in fundamentals, has passed an 8-hour written examination in the principles and practice of engineering given by the Board under this subtitle. OR § 14-305. (d) NON-ACADEMIC OPTION [Note: 12 years Experience, Pass PE exam] (1) An applicant qualifies under this section if the applicant: (i) subject to paragraph (2) of this subsection, has at least 12 years of work experience in engineering that is satisfactory to the Board, in at least 5 years of which the applicant has been in responsible charge, if the collective experience indicates to the Board that the applicant may be competent to practice engineering; and (ii) has passed an 8-hour written examination in the principles and practice of engineering given by the Board under this subtitle. (2) If an applicant has completed 1 or more years of a college or university curriculum in engineering that the Board approves, it may allow, for each of those years, a 1-year credit towards the experience requirement of paragraph (1)(i) of this subsection. (3) If an applicant has completed 1 or more years of a college or university curriculum in engineering that has not been approved by the Board, the Board may allow, for each of those years, a credit of up to 6 months towards the experience requirement under paragraph (1)(i) of this subsection. SUBMIT All Professional Engineer Reciprocity Applicants Candidates must submit : Form 1 R In addition, those engineers not submitting an NCEES Council Record must submit: Form 3 ( to verify current licensure) Form 4 (if graduate of a Non-EAC/ABET approved curriculum, or foreign degree); Form 5 And official transcript, and, if applicable, an evaluation of a foreign degree And, Pay the Application fee of $126.00. Check made payable to: DLLR-PE ************************************************************************************************************************* Instructions Page 2 of 6 DLLR/PL/ENG/R1 (12-13) FORM R1 INSTRUCTIONS FORM 1-PE All Applicants submit Please type or clearly print. Check under which subsection of Section 14-305 of the licensing law application is being made on page 1 and 2 of these instructions to determine under which subsection to file. SECTION 1 -- PERSONAL DATA All applicants must complete all of Sections 1 (Personal Data), AND Indicate if an unexpired license is held, where, the number and the CURRENT expiration date. Please note if an NCEES Council Record is being forwarded to the Maryland Board's Office. SECTION 2 -- CONDUCT QUESTIONS All Conduct questions must be answered. If “YES” to any question(s), submit a letter giving complete explanation and a true test copy of the applicable court document(s). Also, notify the appropriate state licensing board to send a copy of the final order in the case directly to the Maryland Board. Please indicate if subject to Workers Compensation law, and if applicable, the pertinent information. SECTION 3 -- EDUCATION Provide the name(s) of the college/university attended and the type of degree(s) earned and the date of graduation (month/year) and if needed, attach additional information, and so indicate. Official, sealed transcript(s) MUST be requested and sent directly to the Board Office from the College Registrar at the address indicated on Form 1, unless a NCEES Council Record is being submitted. Confirm if college program is EAC/ABET accredited, at www.abet.org/accredited_prgs.html. If applying for licensure by reciprocity under a non-approved curriculum from a college/university in the United States, or with a degree from a foreign college or university, FORM 4 must also be completed, EXCEPT if the applicant's degree is listed in the ABET International Yearbook. Contact www.abet.org to obtain more details. Special Note: Applicants who hold a Technology degree must also complete FORM 4. Applicants with a degree from a foreign university must also submit an official evaluation. SECTION 4 -- REFERENCES Applicants must obtain the signatures of five unrelated persons who can attest to the applicant's good character and reputation. Three of these signatures must be from Professional Engineers, and must include their State/license number. SECTION 5 -- CERTIFICATION All applicants must certify the information provided by signing and date. ************************************************************************************************************************* Instructions Page 3 of 6 DLLR/PL/ENG/R1 (12-13) FORM R-3 – Request For Verification Of Licensure This form must be used to submit verification of current license in another state if a NCEES Council record is not being submitted. Applicant completes the following: Board Of Current Licensure Enter the name and address of the State Board from which verification of licensure is sought. If unsure of mailing address consult www.ncees.org web page for directory of all states’ boards. Personal Data Enter licensee name, address and social security number in the space provided. Send the form to the State Board indicated in Section 1. It is suggested that a postage paid envelope addressed to the Maryland Board be included in the mailing to assist the other State Board in processing the verification request, and also confirm with the other state board if they require a verification fee be sent with the request. The remainder of the form will be completed by the other State Board, signed, sealed and returned directly to the Maryland Board. ************************************************************************************************************************* FORM 4 - Engineering Curriculum Checklist This form must be used if applying for reciprocity licensure under 14-305(c) --with a non-EAC/ABET approved curriculum or with a foreign degree except if the applicant's degree is listed in the ABET International Yearbook. Contact www.abet.org to obtain more details. The regulations regarding Unapproved Option--Engineering Curriculum are available at the PE Board web page at http://www.dsd.state.md.us/comar/subtitle_chapters/09_Chapters.htm#Subtitle23. Click on Professional Licensing, then the PE Board, and On-line laws/reg's. Go to Regulations, and each section of Regulation .09.23.05.05 can then be accessed. Special Note: Applicants who hold a Technology degree must also complete FORM 4. Applicants with a degree from a foreign university must also submit an official evaluation. Please complete full name on form. SECTION A List the names of the colleges/universities attended; the degree(s) awarded and the date the degree(s) was awarded. Then in SECTION B, C, and D, in the first column boxes denote the college/university by the number assigned to it in box A. SECTION B Enter the requested information regarding the MATHEMATICS courses taken, totaling at least 15 semester credit hours. Relevant courses should include differential calculus, integral calculus, and differential equations and should be described as such in the course content column. SECTION C Enter information regarding courses in the BASIC SCIENCES completed, totaling 15 semester credit hours. Relevant courses should include general chemistry and physics with calculus and should be described as such in the course content column. Instructions Page 4 of 6 DLLR/PL/ENG/R1 (12-13) SECTION D Enter information regarding the ENGINEERING courses taken, totaling at least 30 semester credit hours. These courses should: (1) Include a course, project, or thesis that focuses upon engineering design (indicate with ) (2) Incorporate hands on quantitative laboratory work correlated with the science and design instruction.(indicate with) (3) For graduation subsequent to 1975, at least one high level computer language such as FORTRAN or PASCAL so that the student is able to compose computer programs to solve problems in science and design. (Indicate with ) (4) Demonstrate familiarity with probability, statistics, and linear algebra. (Indicate with ) Engineering subject courses shall be selected subject areas such as: Biochemistry, Biophysics & Biomechanics Computer Science Electrical, Electronic & Computer Engineering Engineering Design Finite Element Analysis Geochemistry & Geophysics Physical, Organic & Inorganic Chemistry Transient Analysis & Feedback Control Solid State Physics, Nuclear Physics, Quantum Optics Strength of Materials Civil & Structural Engineering Digital Signals & Systems Electrodynamics Engineering Economics Fluid Mechanics, Hydraulics, & Gas Dynamics Materials Science Sanitary & Environmental Engineering Transfer & Transport Phenomena Statics and Dynamics Thermodynamics SECTION E Provide the requested information regarding advanced courses in MATHEMATICS, SCIENCE, OR ENGINEERING, totaling 15 semester credit hours. ************************************************************************************************************************* FORM 5 - Record of Experience This form must be submitted if a NCEES Council record is not being submitted. Please type or clear print. Indicate applicant's name on line provided. 1. List all engineering engagements held, beginning with the earliest engagement first and list in chronological order. Engagements should be briefly described in the a-b-c indicated in the "Employment Record" column. 2. Indicate the engineering experience claimed during each engagement in years and months in the column provided. 3. Different engagements with the same employer are to be determined by changes in kind of work, or in degree of responsibility. 4. Acceptability of work experience towards fulfillment of the requirements for examination or licensure is determined, in part, by the extent to which the general characteristics of that work conform with the definition of “Practice engineering” as set forth in Business Occupations and Profession Article, Title 14 , Professional Engineers, §14-101(f): “Practice engineering” means to provide any service or creative work the performance of which requires education, training, and experience in the application of: (i) special knowledge of the mathematical, physical, and engineering sciences; and (ii) the principles and methods of engineering analysis and design. In regard to a building or other structure, machine, equipment, process, works, system, project, or public or private utility, “practice engineering” includes: (i) consultation; (ii) design; (iii) evaluation; (iv) inspection of construction to ensure compliance with specifications and drawings; (v) investigation; (vi) planning; and (vii) design co-ordination. Instructions Page 5 of 6 DLLR/PL/ENG/R1 (12-13) 5. Be as specific as possible in describing engineering experience to assure the Board that the experience would qualify the applicant for licensure in Maryland. 6. Make as many copies of Form 5 as needed and number all additional pages used. RECIPROCITY APPLICATION GENERAL INFORMATION FEE The application fee is $126.00, $50 of which is a non-refundable application fee, payable at the time of submission. Make checks payable to: DLLR-PE. APPLICATION REVIEW The Board meets monthly, typically the second Thursday of each month. All completed Reciprocal applications are reviewed and considered at that time. Applications with a "MLE" Model Law Engineering NCEES Council Record are reviewed and approved administratively on an ongoing basis. Board staff reviews pending Reciprocal applications periodically for completeness, and will forward a notice to applicants noting any missing documentation. After three notices an application may be denied for incompleteness. NOTIFICATION Approved applicants are notified in writing shortly after Board/Administrative approval and at that time are provided their license number and directions on how to obtain a copy of their license. Maryland licenses expire two years after the date of issuance. The license renewal fee is $76.50. DLLR mails a notice of renewal with instructions on how to renew approximately 60 days prior to expiration to the address of record. The Board reminds all licensees that it is their responsibility as professionals to maintain their license if they are practicing in Maryland, to renew in a timely manner, and to notify the office of any change of address promptly. Failure to renew may result in additional fines and penalties. SOME HELPFUL HINTS: Before mailing the application, make a photocopy of all forms. Also keep notes of contact with the Registrar's office requesting transcript transmittals. For address changes notify the Board’s office immediately in writing by email at pe@dllr.state.md.us, or fax 410-333-0021. Failure to do so may cause delay in the processing of your application and/or receipt of your licensure approval. ### Instructions Page 6 of 6 DLLR/PL/ENG/R1 (12-13)