STATE OF MARYLAND
DEPARTMENT OF LABOR, LICENSING AND REGULATION
MARYLAND BOARD OF PUBLIC ACCOUNTANCY
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500 N. CALVERT STREET, THIRD FLOOR, BALTIMORE, MARYLAND 21202-3651
410-230-6258 FAX: 410 333-6314
www.dllr.state.md.us
TTY users use Maryland Relay Service 1-800-735-2258
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Original Applicants must provide
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CPA EXAMINATION APPLICATION
FOR FIRST TIME CANDIDATES
November 6 & 7, 2001
Filing Deadline: …..August 8, 2002
Education Credential Review and Examination Fee - $ 275
Applicant's who are filing for the examination within the last two weeks before the deadline should consider using express, overnight or
personal delivery. The individual candidate is responsible to ensure that this application and supporting documents are received in the
offices of the Board of Public Accountancy before 5:00 PM on the deadline date. Postmarks are not acceptable.
Part A. PREFERRED TEST SITE:
BALTIMORE AREA
WASHINGTON METRO
Part B. OUT OF STATE PROCTORING: Indicate where you want


to take exam.
CITY: ____________________________ STATE _________
The Board will make every attempt to seat you at your preferred
site. However, the Board reserves the right to assign you to a
different site should candidate volume and other circumstances
warrant .
Candidates seeking approval for proctoring must meet the conditions
set forth in the Board's Proctoring Policy. (See back page for policy on
proctoring.)
Part C.
1. Are you requesting special examination accommodation
pursuant to the American's With Disabilities Act? (Attach medical documentation)
YES
NO
2. Are you requesting special examination accommodation
due to an acute medical condition? (Attach medical documentation)
YES
NO
Part D. LEAVE ONE SPACE BETWEEN EACH WORD
1. NAME
LAST (SURNAME) AND SUFFIX (JR., III, ETC.)
FIRST NAME
MIDDLE NAME
MAIDEN NAME
2. U.S. SOCIAL
SECURITY NO.
U.S. Social Security Number
3. ADDRESS
HAVE YOU CHANGED YOUR
MAILING ADDRESS , SINCE
YOU LAST APPLIED FOR THE
CPA EXAMINATION?
YES
NO
STREET ADDRESS (EXAMPLE: 1024 EXAM STREET, IN CARE OF)
ADDITIONAL ADDRESS (EXAMPLE PO BOX RURAL ROUTE NO., APT NO., ETC)
CITY
STATE/PROVINCE
BUSINESS TELEPHONE NUMBER
ZIP CODE
COUNTRY
HOME TELEPHONE NUMBER
INTERNET E-MAIL ADDRESS (INCLUDE [DOT] AND @)
4. DATE
OF BIRTH
MONTH
5. EXAM STATUS
ANSWER EACH OF THESE
QUESTIONS BY CHECKING
"YES" OR "NO".
IF YES, SEE INSTRUCTIONS.
DAY
YEAR
1. Have you ever been denied the right to sit for the exam as a Maryland Candidate?
2. Have you ever taken the CPA exam in another state?
3. Are you claiming credit from another state?
If yes, which state? _______________
YES
YES
YES
NO
NO
NO
4. Have you ever been convicted of, or received probation before judgement for any drug offense committed after
January 1, 1991?
YES
NO
5. Have you ever been convicted of a felony or misdemeanor in any State or Federal Court?
6. APPLICATION FOR
ACCOMMODATIONS
UNDER THE
AMERICANS WITH
DISABILITIES ACT.
7. CANDIDATE
STATEMENT
YES
NO
The Maryland Board of Public Accountancy complies with the Americans With Disabilities Act in
accommodating candidates with special needs. If you require such accommodations, be sure to indicate
your request for accommodations on the first page of this application and submit appropriate documentation
with this application by the filing deadline noted on the front of this application. You must also specifically
request the accommodation needed. If documentation is not received by the application deadline, the
applicant will be scheduled for the examination subsequent to the one that the applicant indicated on the
application.
"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 herein within this application to an authorized representative of the
Department of Labor, Licensing and Regulation for further investigation.
Signature of Candidate ___________________________________________ Date __________________
Reminder to Original Applicants!
Attachment Checklist


Most recent photograph of applicant
Course Requirement Checklist
Official Transcript reminder

I have notified each educational institution where I have
completed courses and or have earned a degree to send
copies of my official transcripts to the Maryland Board of Public
Accountancy. (Your application will not be processed unless
The Board receives your official transcripts directly from
your school(s).
Policy on Proctoring
The Maryland Board of Public Accountancy policy on proctoring affects both out-of-state candidates who wish to proctored at a
Maryland test site and Maryland candidates who wish to proctored in another state. A candidate must meet one of the following
situations:
Must be enrolled in a college/university in the state where proctoring is requested at the time of the examination; need original
letter from Registrar of college to indicate your student status.
Must be on military assignment in the state where proctoring is requested at the time of the examination; need copy of Military
orders.
Must be on temporary work assignment in the state where proctoring is requested at the time of the examination; need original
letter from employer to indicate your temporary employment.
Documentation to support the request must be submitted to the Maryland Board of Public Accountancy 90 days prior to the first day of
the examination. Candidates will be notified by letter or e-mail of the Board's decision. Proctoring is a courtesy extended on a limited
basis by state boards of public accountancy and is not guaranteed.
FOR OFFICIAL USE ONLY
Received _____________________
Fee $ _______________________ Check
Clerk's Initials
______________
MO