Georgia Pe Comity Application – Fill Out and Use This PDF

GEORGIA STATE BOARD OF PROFESSIONAL ENGINEERS & LAND SURVEYORS

237Coliseum Drive • Macon, Georgia 31217 • (478) 207-2440 www.sos.ga.gov/plb/pels/

APPLICATION FOR CERTIFICATE AS A PROFESSIONAL ENGINEER

Application Fee $70 (non-refundable)

License Type: PROFESSIONAL ENGINEER

Additional License Types (currently or previously issued by the Georgia Professional Licensing Boards): ___________________________________

Method Obtained by: Applicant is applying for above referenced license by: Comity Original PE license from the State of _______________

Name as desired on License (First, Middle, Last, Suffix): ________________________________

Name as shown on exam records or transcripts (First, Middle, Last, Suffix):

(if different) _____________________________________

Social Security Number: ____ -____-_______ Date of Birth: ___/___/_____

Physical Address: # Street __________________ Apt/Ste: ______ City: ______ State ___ Zip _____

P.O. Box not acceptable for Physical Address

Mailing Address: # Street __________________ Apt/Ste: ______ City: ______ State ___ Zip _____

(if different)

Telephone Day: (____) ____- _____ Telephone Evening: (____) ____-_____

E-Mail Address: __________________________

Affiliation:

Name of firm: __________________________________________

Physical Address: # Street __________________ Apt/Ste: ______ City: ______ State ___ Zip _____

P.O. Box not acceptable

Mailing Address: # Street __________________ Apt/Ste: ______ City: ______ State ___ Zip _____

(if different)

NOTE TO APPLICANT: This information will be entered into the Division database for Accounting and Licensing purposes. All items must be completed, and then duplicated on the next page of the application for Board review.

APPLICATION FOR REGISTRATION AS A PROFESSIONAL ENGINEER BY COMITY

Note: NCEES Record Holders are required to completely fill out sections 1 through 5. NCEES Record Holders are not required to submit endorsements, verification of licensure/exams or transcripts as those items are part of the NCEES Record.

Which one branch of engineering do you propose to practice in the state of Georgia? _________________

Designate the special branches of engineering in which you have been examined: ___________________

Present Employer __________________________________________ Position: ___________________

Note: It is the Board’s policy for Comity applicants who practice or propose to practice Structural Engineering and have taken the PE exam in a discipline other than Structural, to have a minimum of 60 months of Structural engineering experience after successful examination acceptable to the Board at the time of application.

Revised 07-12

If registered by written exam, indicate number of hours for the exam (“0” if no exam taken): ____

Indicate exam options taken: _______________________

List all states in which you are currently registered as a PE: _______,_______,_______,_______,_______

List other states and types of registration for which you have applied or are currently applying but do not have final notification of registration: _______,_______,_______,_______

NOTE: If you hold an NCEES Council Record and plan to submit it in lieu of endorsements, verification of licensure/exam and transcripts, then you should completely fill out Sections 1 through 5 of this application and contact NCEES to have them electronically transmit your NCEES record to the Georgia Board for consideration. For further information regarding an NCEES Council Record, please contact NCEES at www.ncees.org or 1-800- 250-1396.

NOTE: If you do not hold an NCEES Council Record, you will need to bundle and send with your application:

Official transcripts for each college attended, whether you graduated or not

Evaluation of foreign degree (if you earned your bachelor’s degree outside the US) from an approved provider. If you choose not to have an evaluation, you will need to send a letter indicating so.

Verification of original exam/licensure of both the EIT and PE, and if different, verification of licensure from the state where you live now. If you are not licensed in your residence state, indicate in Section 1.

Endorsements for all experience you list in Section 3. You must have at least five endorsements/references from five (5) individuals, three (3) of which must be currently active PE’s, that are not related to you by

blood or marriage, are not Board members and who have personal knowledge of your engineering experience, reputation and accomplishments.

All of the above supporting documentation must be sent to the Board in sealed envelopes, with the back flap signed to ensure no tampering. Some states/agencies/individuals prefer to send their documentation directly to the Board, which is permissible. This information will be maintained at the Board office and added to the application file upon receipt.

NOTE: Be sure to sign your application and have your signature notarized (Section 5.)

Note: List all engagements of engineering experience beginning with the earliest and ending with your current position. Endorsement form (Section 6) should correspond with this section. All engagements listed must be described on an endorsement form and someone familiar with your work (preferably your supervisor) should endorse it.

From _______________To ______________

Description ___________________________________________________

From _______________To ______________

Description ___________________________________________________

From _______________To ______________

Description ___________________________________________________

Georgia State Board of Registration for

Professional Engineers & Land Surveyors

VERIFICATION OF OUT-OF-STATE LICENSURE

EXAMINATION AND REGISTRATION

Instructions to the Applicant:

1.The Applicant should:

a.Complete his or her name and address on the top portion, upper right corner on the reverse side of this form.

b.Fill in the name of the state board completing this form.

c.Forward this form to the out-of-state board where the applicant is certified or registered.

2.Comity Applicants should:

a.Submit a form to the state of their Engineer-In-Training (EIT) and to the state of their initial Professional Engineer (PE) registration.

b.If registration is not currently valid in the state of the initial registration, submit a form to the state where a current valid registration is held.

c.If the applicant currently lives in a state other than initial licensure, submit a form to that state. If the applicant is not licensed in the state of residence, please indicate in Section 1 of the application.

3.This form may be copied if necessary.

Notes to applicant:

1.It is the policy of some states/agencies is to only send the verification/documentation directly to the Georgia Board rather than to the applicant. This is permissible.

2.It is the policy of some states/agencies to charge a fee for verification and if so, the state will not process the request until the fee is received. Before you mail this verification request to the state Board, check their website or call them to verify their fee policy.

Instructions to the Out-of-State Board:

The Out-of-State Board should complete Sections 1 - 4 on the reverse side of this form, enter the appropriate state name, and return to the applicant in a sealed envelope with an official signature on the flap of the envelope to assure no tampering. The Georgia Board will not accept this form to be transmitted via e-mail or fax.

REQUEST FOR VERIFICATION OF REGISTRATION OR EXAMINATION FOR PE COMITY APPLICANT

1.THE ABOVE NAMED PERSON WAS CERTIFIED OR REGISTERED AS:

2.BASIS OF REGISTRATION:

Other: ____________________________________________________________________

3.QUESTIONS:

By:_____________________________________ Title:___________________________ Date:__________

Verifying State:____________________________

(If a fee is required, please notify the applicant but do not delay the processing of this form)