Rhode Island Examination Information
NCEES EXAM ADMINISTRATION SERVICES FOR
- First Time and Repeat - Deadline for applications to Board
opens.
- NCEES Exam Administration Services registration
deadline.
- NCEES Exam Administration Services registration
- Deadline for examinees to submit ADA and Religious
Accommodation requests to NCEES (refer to NCEES Web site for
application): www.ncees.org/exams/special_accommodations/
- Cancellation deadline.
2-3 weeks before exam - Distribute exam authorization notices to
candidates. Candidates will be notified via email that the authorization
notices are available through their online account, and should be printed
to bring with them for admission on exam day.
- Exam administration.
Rhode Island Examination Information
Rhode Island Approval and Registration Information
If you are planning to register for the exam in Rhode Island, read ALL information on this page before proceeding with
registration.
State Approval Application Deadlines for April 2014
All Applicants (First-Time and Repeat): Postmarked by January 1, 2014
Please review all information and policies provided on the Registration Information page to ensure you understand the entire
exam process.
If you have any questions about the process, email NCEES Exam Administrative Services using the feedback form or call us
(877) 536-7729.
First-time examinees must complete the Rhode Island Board's application for examination found at the Rhode Island
Board Web site (this will be a link to http://www.bdp.state.ri.us/).
Re-examination examinees who have been previously approved by the Rhode Island Board must submit a letter of
request to the Rhode Island Board. All repeat examinees must reschedule with the Rhode Island Board to be
considered approved.
Once you have received approval notification from the Rhode Island Board, you must register with and pay exam fees
to NCEES Administrative Services to reserve your seat for the exam.
To ensure you receive all email communications from NCEES Exam Administrative Services without delay, please add
noreply@els-examreg.org to your address book. If your email provider allows, you should also make els-examreg.org
a safe domain for receipt of your emails.
Admission authorization notices: You will receive an email from NCEES Administrative Services 3 to 4 weeks before the
examination indicating that your admission authorization notice is available to be downloaded and printed for exam day. If
you have problems logging in to your account, please contact NCEES Exam Administrative Services for assistance. A
link to the NCEES Candidate Agreement will be in your email announcement for you to review prior to exam day. On exam
day, you will be required to sign your answer sheet affirming you have read and understand the information in the NCEES
Candidate Agreement and will abide by the stated policies, procedures, and conditions.
If you do not provide an email address to NCEES Exam Admintrative Services, your admission notice will be mailed
to you via the U.S. Postal Service.
NCEES releases exam results to the Rhode Island Board 10 to 12 weeks after the exam date.
Fees - Rhode Island application fee is $100.00
Note: If you register for an examination and have not been approved by the Rhode Island Board, your exam fee will
NOT be refunded. If you are not sure whether you have been approved or whether you are eligible to sit for an
examination, contact the Rhode Island Board before registering.
Exam Sites
Locations are available on a first‐come, first‐served basis. If the location reaches maximum capacity, you will be
moved to the next available location.
Exact location, building, and room information will be on your admission authorization notice. It is your
responsibility to obtain directions and ensure that you arrive at the exam site on time on the day of the exam. If
you need specific driving directions, please refer to the exam site’s Web site (if provided) below or use an Internet
search engine such as Google or Yahoo.
Exam Times and Schedule
Review the exam day timeline.
Examination
Day
PE
Friday
PS
Friday
Date
Report time
Length
Open/Closed Book
April 11
7:15 am
8 hours
Open Book
April 11
7:15 am
6 hours
Open Book
Afternoon report times will be announced during the morning session.
Examinee admissions will take place from 7:15–7:40 a.m. The exam room doors will be closed at 7:40 a.m. Absolutely no
examinees will be allowed in the exam room after 7:40 a.m. It is your responsibility to take necessary precautions to
ensure you arrive on time. All examinees must be seated when instructions begin at 7:40 a.m.
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
IMPORTANT INFORMATION
Effective 11/18/2008
Only complete application packages will be accepted in this office.
All required documentation must be in sealed envelopes and must
be submitted with the application and fee. Incomplete packages will
not be processed and will be returned to the applicant.
Revised: 11/18/2008
ApplicationFee
$100.00No.
IMPORTANT – Do not fill out application until you read and understand this form and the enclosed “Instruction Sheet”.
RHODE ISLAND
STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS
2nd 1511 Pontiac Ave, Building 68-2, Cranston, RI 02920
(401-462-9592) (401-462-9532 Fax)
Application for Registration to Practice
Professional Engineering
1. GENERAL INFORMATION
Social Security #
Name in Full
Last
First
Date
Email: ____________________________
M
*
Residence Address
Name of Employer
*
Business Address
* Please Check Box for Preferred Mailing Address
Present Position
Date of Birth
, 20
Citizenship
Attach in this space unmounted
recognizable recent photograph
with face not less than _ inches
wide.
Photograph taken more than six
months prior to filing application
is not acceptable. Professional
passport type required.
Do not use staples when
attaching photograph. Paste or
cellophane tape may be used.
Legal Resident of what State
When did you become a Resident?
AFFIX SIGNATURE ON
PHOTO AT THE BOTTOM.
What Section of RI G.L. 5-8-11 are you applying under
In what branch(s) of engineering are you proficient?
Have you previously applied or held registration in RI? Yes
No
Give names, addresses, and zip codes of five or more references, not relatives, not business partners, not members of the Board, not also given
under Section 5, not less than three of whom are registered engineers having personal knowledge of your character and professional reputation.
Name
Address
Position
Registration Number
1.
2.
3.
4.
5.
2. MEMBERSHIP IN SOCIETIES, ASSOCIATIONS, OR INSTITUTES
(Professional or Scientific)
Name of Organization
Grade of Membership
Date
3. PREVIOUS REGISTRATIONS
Name of State
Year
How Registered (written or oral examination,
Classification
Active or
Registered
record only, “grandfather clause”, reciprocity, etc.
Lapsed
and
Cert. #
Have you taken an E.I. T. test? If so, give name of state, year and certificate #
Have you ever had registrations refused in any state?
________________________If so attach statement giving full particulars.
Have you ever had disciplinary action taken in any state? ________________________
If so attach statement giving full particulars.
IT IS YOUR RESPONSIBILITY TO INFORM THIS OFFICE OF A CHANGE OF ADDRESS
Revised: 5/26/2010
4. EDUCATION
(State in chronological order the name and location of each high or preparatory school, college, university, or technical school attended, the time spent at each and if a graduate, the
year of graduation. If not an Engineering graduate, outline nature and extent of studies.) SCHOOLS WITHOUT COMPLETE ADDRESSES AND ZIP CODES WILL
RESULT IN THE RETURN OF THE APPLICATION.
Complete School Name
and Address
Years
From – To
Date Graduated
(month & year)
Engineering
Curriculum
Degree
Received
5. PROFESSIONAL EXPERIENCE
a.
b.
c.
d.
(IMPORTANT – READ ALL INSTRUCTIONS IN THIS SECTION BEFORE FILLING OUT FORM)
Each of the five columns under “Time” should be filled out for each engagement. Use Zeros where necessary, but do not leave blank spaces and do not use the word “yes”.
The time “In Sub-Professional Work” plus the time “In Professional Work” must equal the time entered under “Total Time”. Columns 2 and 3 must equal Column 1.
If any of the time given as “In Professional Work” has been “In Responsible Charge” or also “In Design”, enter the portion of the time thus spent in the proper column.
If the same period of time is spent in “Responsible Charge” and also “In Design”, it should be entered in both columns (4) and (5).
APPLICANT MUST FILL OUT ALL COLUMNS
Number of
Engagement
DATE
From
To
TITLE OF POSITION, NAME OF EMPLOYER, AND
CHARACTER OF ENGAGEMENT
(Make statement brief and concise; any necessary
implications may be made by letter)
(1)
Total
Time
Actual
TIME
In years and months
(2)
(3)
(4)
In SubIn ProIn ReProfessional sponsible
Fessional
Work
Charge
Work
(Actual) (Actual)
(Actual)
(5)
In
Desgin
(Actual)
Name, Address and Zip Code
of someone familiar with
each engagement
preferably the person to
whom applicant reported
Summary (Actual Time) Total
PLEASE DO NOT FILL IN
Summary (Rated Years of Active Practice)
SUB-PROFESSIONAL WORK is to cover the time spent as Recorder, Draftsman, Superintendent of Construction or Clerk of the works; or similar work; and also time
spent as inspector when working under direct supervision or on work where the personal responsibility and technical knowledge required are small; that is, minor positions in
which the responsibility is slight and the individual performance of a task, set and supervised by a superior, is all that is required. It shall also include time during which he/she has
been occupied in engineering work before the applicant is 21 years of age, except as modified by statement in regard to education in the definition of Professional Work.
PROFESSIONAL WORK shall include the time after the applicant is 21 years old, during which he has been occupied in engineering work of higher grade and
responsibility than that above defined as Sub-Professional Work. Time spent in teaching of Engineering subsequent to graduation shall be listed as Professional Work. Education
shall be considered as Professional Work. No more than four years of active practice shall be credited because of educational qualifications.
RESPONSIBLE CHARGE OF WORK means:
a. In the field, the applicant must have had the direction of work, the successful accomplishment of which rested upon him, where he/she had to decide questions of methods
of execution and suitability of materials, without relying upon advice or instructions from his/her next superiors, and of supplying deficiencies in plans or correcting errors in
design without first referring them to higher authority for approval, except in cases where such approval is a mere matter of form.
b. In the office, the applicant must have had to undertake investigations or carry out important assignments, demanding resourcefulness and originality, or to make plans,
write specifications, and direct drafting and computations for designs of engineering work, with only rough sketches, general information and field measurements for reference and
guidance.
c. In teaching, the applicant must have taught in an engineering school of ABET standing, upon an approved curricula, and must have had, at least, a grade of assistant
professor, or its equivalent.
DESIGN means all that is given above as responsible charge of work in the office and more. One qualified to design must be able in the case of any desired piece of
engineering, to meet the exigencies of the case, to fulfill the requirements of local circumstances and conditions, and yet not violate any of the canons of engineering. His/her
plan, when executed, must successfully answer the purpose for which it was designed.
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
15112nd
Pontiac Ave, Building 68-2
Cranston, RI 02920
P
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
6. EXAMINATION RECORD
PLEASE LIST EACH AND EVERY TIME THAT YOU HAVE TAKEN THE FUNDAMENTALS OF ENGINEERING
(EIT) EXAMINATION AND THE PRINCIPLES & PRACTICE (PE) EXAMINATION.
APPLICANT’S NAME & ADDRESS
_________________________________________________
_________________________________________________
_________________________________________________
COMPLETE ALL INFORMATION REQUESTED BELOW.
EXAM
DATE
STATE
RESULTS
Pass
Fail
Please fill in the following:
I have taken the Fundamentals of Engineering Exam (EIT) a total of __________ times.
I have taken the Professional Engineer Exam (PE) a total of ___________ times.
I am the applicant named in this application and certify under penalty of perjury that the foregoing is true and correct in every respect.
DATE EXECUTED ON: __________________________________________
PRINT NAME: ____________________________________________
Revised: 11/18/2008
(This space not to be used by Applicant)
RECORD OF BOARD
Check No.
Date
Name of Applicant
Amount of fee paid $
Considered by Board
Action of Board
Personal interview held
Date
Date of Registration
Number
Certificate mailed
Discipline
Examination given:
Engineering Fundamentals
State
Score
State
Score
Date
State
Score
State
Score
Date
State
Score
Date
Date Application Received
Score
Date
Secretary Notes
State
Date
Date
Score
Date
Exam Reviewed By:
State
Date
Professional Engineering
Date
State
Score
Tax Payer Status Affidavit / Identity Verification
All persons applying or renewing any license, registration, permit or other
authority (hereinafter called “licensee”) to conduct a business or occupation in the state of
Rhode Island are required to file all applicable tax returns and pay all taxes owed to the
state prior to receiving a license as mandated by state law (RIGL 5-76) except as noted
below.
In order to verify that the state is not owed taxes, licensees are required to provide their
Social Security Number and Federal Tax Identification Number as appropriate. These
numbers will be transmitted to the Division of Taxation to verify tax status prior to the
issuance of a license. This declaration must be made prior to the issuance of a license.
Please return this affidavit along with your license application to: Rhode Island
Department of Business Regulation, 1511 Pontiac Avenue, Cranston, RI 02920.
Licensee Declaration
I hereby declare, under penalty of perjury, that I have filed all required state tax
returns and have paid all taxes owed.
I have entered a written installment agreement to pay delinquent taxes that is
satisfactory to the Tax Administrator.
I am currently pursuing administrative review of taxes owed to the state.
I am in federal bankruptcy. (Case #_____________________________)
I am in state receivership.
(Case #_____________________________)
I have been discharged from Bankruptcy. (Case #__________________)
________________________________________________________________________
Type of Professional License for which you are applying
___________________________________
Full Name (Please Print or Type)
_____________________________________
Social Security Number (or FEIN if appropriate)
___________________________________
Signature
______________________________________
Phone Number (including area code if not 401)
Date_______________________________
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
INSTRUCTION SHEET
Application Fee is $100.00
APPLICATION - Applicant must submit a complete application package. All required forms and documentation must be in sealed
envelopes and attached to the application. Provide reference and verification forms with a stamped self-addressed envelope . It is
imperative that all information requested on the application be completed and the photograph affixed and signed. Application and/or
documentation received, which are not in sealed envelopes or are incomplete will not be reviewed or considered by the Board and the
entire application package will be returned to the applicant.
APPLICATION DEADLINE DATE FOR EXAM - Application and all required documentation must be received or postmarked by
January 1 for the April examination and by August 1 for the October examination. Applications received after these dates will be
considered for the following test administration.
I.
GENERAL INFORMATION
A. Complete all personal information. Be sure to affix your signature across your photo.
B. General Reference Form: The information on this form pertains to the applicant. On the application, list five
(5) people, who can be used as references, not less than three (3) of whom are registered engineers and are not relatives,
business partners, members of the Board. Indicate their addresses, present positions and registration numbers in the space
provide. Individuals listed in this section cannot again be listed under Section 5.
II.
MEMBERSHIP IN SOCIETIES, ETC.
A. Self-explanatory.
III.
REGISTRATIONS
A. The information requested in this section relates to the state in which you were originally registered by exam as a
engineer-in-training and/or professional engineer. Complete all categories.
B. You must send a Verification of Registration form to the state where you were originally registered by engineer-intraining and/or professional engineer exam. You are responsible for any verification fees. Contact the appropriate state board
for verification fees. The Verification of Registration form can be sent directly to this Board or to the applicant in a sealed
envelope. The applicant must send in the sealed envelope with their application.
C. Answer the remaining questions regarding your E.I.T. and information regarding any disciplinary action.
D. Supplemental Information Form - Complete in full and return.
(Over)
Revised: 11/18/2008
INSTRUCTION SHEET (cont’d.)
IV.
EDUCATION
A. Rhode Island law requires a four (4) year Bachelor of Science undergraduate degree in engineering for registration.
B. You must send a Verification of Education form to the appropriate university if in the United States. The
Verification of Education form can be sent directly to this Board or to the applicant in a sealed envelope. The applicant must
send in the sealed envelope with their application.
C. As of September 5, 2006 if a degree is received from a foreign institution, the applicant must have his/her education
evaluated through the NCEES Credentials Evaluations Servicess, 280 Seneca Creek, Seneca, SC 29678 Phone 800-250-3196,
Fax 864-654-6824, and website http://www.ncces.org/Credentials_evaluations.php. ��The Board will only accept those
evaluations dated from September 4, 2004 thru September 4, 2006 from Engineering Credentials Evaluation International (ECEI)
V.
PROFESSIONAL EXPERIENCE
A. Begin with your present position.
B. Number each engagement.
C. List “from and to” dates in months and years.
D. Please note: The Board only recognizes experience obtained after receipt of a Bachelor of Science degree in
Engineering.
E. Fill in title of position, name of employer and a detailed description of duties and responsibilities, not projects.
If this description does not fit in the block provided on the application, an attachment must be submitted
accordingly. This information must also be inserted on the Verification of Professional Experience forms.
Each engagement requires a separate Verification of Professional Experience form.
F. Indicate the name and address of the individual familiar with each engagement who will be responsible for
completing the Verification of Professional Experience form.
G. Time columns are to be broken down into five (5) sections as indicated on the application. Definitions of each
column are given at the bottom of Section 5 on the application. Complete all five (5) columns at the bottom of this
section. Do not leave blank columns.
H. You must complete the summary (actual time) total for all five (5) columns at the bottom of this section. Do not
leave blank columns.
CHECKLIST…Please verify that the following are included in your application.
□
□
□
□
Verification of Education in a sealed envelope. .
All information in Section 1 is completed in full.
Signature on your affixed photograph.
Examination Record
Check for $100.00 payble to: Treasurer, State of RI.
□ Five (5) General reference forms in sealed envelopes.
□ Verification of Professional Experience forms in sealed envelopes.
□ Verification of Registration from the state board of initial
registration in a sealed envelope.
□
Tax Payer Affidavit. __ Selection of exam module
Revised: 5/26/2010
Please indicate in the appropriate block below which afternoon module you wish to take. You may
only choose one (1) module and you will not be allowed to change your choice at any time.
CIVIL – CONSTRUCTION
CIVIL – GEOTECHNICAL
CIVIL – STRUCTURAL
CHEMICAL
I
ENVIRONMENTAL
CIVIL - TRANSPORTATION
CIVIL – WATER RESOURCES & ENVIRONMENTAL
ELECTRICAL & COMPUTER - COMPUTERS
ELECTRICAL & COMPUTER – ELECTRONICS, CONTROLS AND COMMUNICATION
ELECTRICAL & COMPUTER – POWER
MECHANICAL – HVAC and REFRIGERATION
MECHANICAL – MACHINE DESIGN
MECHANICAL – THERMAL and FLUIDS SYSTEMS
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS
RULES OF THE BOARD
IV- EXAMINATIONS (2.)
SUBJECT:
Board Policy on the number of times an applicant may be allowed to take the Fundamentals
of Engineering (FE) or Professional Engineer (PE) exams.
1.
That a qualified applicant will be allowed to take the FE or PE exam a total of three (3) times. This
would be an aggregate total regardless of where the exam was taken.
2.
An applicant who has failed three (3) times, may request permission to take the exam for a fourth
and final time, if:
a)
Their score on their last attempt was a minimum of sixty (60) and
b)
They agree to take and complete an appropriate review course or graduate courses in
areas of their deficiency and submit written proof to the Board of having successfully
completed such course or courses.
3.
An applicant who fails the FE or PE exam a total of four (4) times, regardless of where or when the
exam was taken, shall not be allowed to take the exam in Rhode Island, nor be granted a registration
by reciprocity or comity should they pass it at a future date in a different state or jurisdiction.
4.
An applicant who does not properly inform the Board of previous attempts to pass the exam in
another state or jurisdiction, if such information comes to the Board’s attention, shall be barred from
taking any more exams in Rhode Island or shall have any license gained in Rhode Island revoked.
5.
If an applicant obtains an additional engineering degree from an ABET accredited school then the
Board may grant relief from these provisions for good cause shown.
Revised: 11/18/2008
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
2nd
r Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
GENERAL REFERENCE FORM
APPLICANT’S NAME & ADDRESS
Please return this form directly to the applicant in a sealed envelope.
To:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
The above listed individual has filed an application for a certificate of qualification as a Professional Engineer with this Board.
Please complete the information requested below and furnish any additional information, which may be of value to the Board
when reviewing the application.
Information furnished by references is for the confidential use of the Board and the source and character of this information
will not be divulged except in special cases when requested by other legally authorized State Boards of Registration.
1. GENERAL INFORMATION
PRESENT POSITION
OF APPLICANT
NUMBER OF
YEARS KNOWN
NUMBER OF YEARS
ENGAGED IN ACTIVE
ENGINEERING
NUMBER OF YEARS IN
RESPONSIBLE CHARGE
OF ENGINEERING
WORK
NUMBER OF
YEARS ENGAGED
IN DESIGN OF
ENGINEERING
WORK
Applicant’s character and personal reputation are ____________________________________________
In your opinion is the applicant competent to be placed in responsible charge of important engineering work? ___________
________________________________________________________________________________________________________________________________________________________
Remarks: __________________________________________________________________________________________
AUTHORIZED SIGNATURE: __________________________________________
TELEPHONE NO. __________________
PRINT NAME: ____________________________________________
TITLE: ______________________________________________________
Are you a Registered Professional Engineer? _________ Yes __________ No
Revised: 11/18/2008
DATE: ____________________________
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
VERIFICATION OF REGISTRATION
STATE BOARD NAME & ADDRESS
Please return this form directly to the applicant in a sealed envelope.
To:
APPLICANT’S NAME & ADDRESS
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Social Security No:
_______________________________
Date of Birth:
______________________________
I. THE ABOVE NAMED PERSON WAS REGISTERED AS:
Certificate No.
ENGINEER IN TRAINING
PROFESSIONAL ENGINEER
□
□
Date Issued
Valid until
FE
____________
______________
__________
PE
____________
______________
__________
II. BASIS OF REGISTRATION:
□ 1.
WRITTEN EXAMINATION
Hours
Score
Waived
Exam Date
NCEES
Fundamentals of Engineering (FE)
_______
________
_______
__________
_________
Principles & Practice of Engineering (PE)
_______
________
_______
__________
_________
EXAM DISCIPLINE: _____________________If your state does not license by discipline please check here________.
□
2. ORAL EXAMINATION:
□
3. E.I.T. ACCEPTED FROM: __________________________________________________________________________________________
□
4. P.E. ACCEPTED FROM: ___________________________________________________________________________________________
□
5. EDUCATION AND EXPERIENCE: If less than 8 years experience including graduation from ECPDD engineering curriculum, please check
here___________ and give details on the other side.
□
6. OTHER: Please give full details on the other side.
FE Hours: _________
PE Hours: _________
III. QUESTIONS:
Yes
No
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?
_____
_____
If not, give details. __________________________________________________________________________________________________
IV. __________ PLEASE SEE OTHER SIDE FOR FURTHER EXPLANATION OR COMMENTS.
AUTHORIZED SIGNATURE: _________________________________________
TELEPHONE NO. ____________________________
PRINT NAME: ______________________________________________________
TITLE: ____________________________________________________________
Revised: 11/18/2008
DATE: ______________________________________
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
15112nd
Pontiac Ave, Building 68-2
Cranston, RI 02920
P
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
VERIFICATION OF PROFESSIONAL EXPERIENCE
APPLICANT’S NAME & ADDRESS
Please return this form directly to the applicant in a sealed envelope.
To:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
________________________________________________
The above listed individual has filed an application for a certificate of qualification as a Professional Engineer with this
Board. Please complete the requested information below and furnish any additional information, which may be of value to the
Board when reviewing the application.
Information furnished by references is for the confidential use of the Board and the source and character of this information
will not be divulged except in special cases when requested by other legally authorized State Boards of Registration.
5. PROFESSIONAL EXPERIENCE
FROM
DATES
TO
NAME OF EMPLOYER
SUB-PROFESSIONAL
WORK
(YRS.)
PROFESSIONAL
WORK
(YRS.)
RESPONSIBLE
CHARGE
(YRS.)
DESIGN
(YRS./MONTHS)
List position and a brief description of duties and responsibilities: ___________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
In your opinion is the applicant qualified to have responsible charge of important engineering work? ____________
In your opinion is the applicant qualified to design engineering work? ____________
In your opinion, the applicant’s character and personal reputation are ____________________________________________
Remarks: __________________________________________________________________________________________
AUTHORIZED SIGNATURE: __________________________________________
TELEPHONE NO. __________________
PRINT NAME: ____________________________________________
TITLE: ______________________________________________________
Revised: 11/18/2008
DATE: ____________________________
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
Cranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
VERIFICATION OF EDUCATION
UNIVERSITY NAME & ADDRESS
Please return this form directly to the applicant in a sealed envelope.
To:
APPLICANT’S NAME & ADDRESS
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
Social Security No:
_______________________________
Date of Birth:
______________________________
The above listed individual has filed an application for a certificate of qualification as a Professional Engineer with this
Board. Please complete the information requested in the sections below and furnish any additional information, which may be of
value to the Board when reviewing the application.
Information secured from references is for the confidential use of the Board and the source and character of this information
will not be divulged except in special cases when requested by other legally authorized State Boards of Registration.
The Rhode Island State Board of Registration for Professional Engineers requires that the
specific “Type of Degree(s) Received” be filled in by the Registrar’s Office. (i.e., B.S. in Civil Engineering)
4. EDUCATION
YEARS
FROM
TO
DATE GRADUATED
TYPE OF DEGREE RECEIVED
Remarks: __________________________________________________________________________________________
AUTHORIZED SIGNATURE: __________________________________________
TELEPHONE NO. __________________
PRINT NAME: ____________________________________________
TITLE: ______________________________________________________
Revised: 11/18/2008
DATE: ____________________________
STATE OF RHODE ISLAND
Bd. of Registration for Professional Engineers
1511 Pontiac Ave, Building 68-2
2nd F
PCranston, RI 02920
(401) 462-9592 Fax: (401) 462-9532
www.bdp.state.ri.us
VERIFICATION OF PROFESSIONAL EXPERIENCE
APPLICANT’S NAME & ADDRESS
Please return this form directly to the applicant in a sealed envelope.
To:
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
________________________________________________
The above listed individual has filed an application for a certificate of qualification as a Professional Engineer with this
Board. Please complete the requested information below and furnish any additional information, which may be of value to the
Board when reviewing the application.
Information furnished by references is for the confidential use of the Board and the source and character of this information
will not be divulged except in special cases when requested by other legally authorized State Boards of Registration.
5. PROFESSIONAL EXPERIENCE
FROM
DATES
TO
NAME OF EMPLOYER
SUB-PROFESSIONAL
WORK
(YRS.)
PROFESSIONAL
WORK
(YRS.)
RESPONSIBLE
CHARGE
(YRS.)
DESIGN
(YRS./MONTHS)
List position and a brief description of duties and responsibilities: ___________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
In your opinion is the applicant qualified to have responsible charge of important engineering work? ____________
In your opinion is the applicant qualified to design engineering work? ____________
In your opinion, the applicant’s character and personal reputation are ____________________________________________
Remarks: __________________________________________________________________________________________
AUTHORIZED SIGNATURE: __________________________________________
TELEPHONE NO. __________________
PRINT NAME: ____________________________________________
TITLE: ______________________________________________________
Revised: 11/18/2008
DATE: ____________________________
