MARYLAND DEPARTMENT OF LABOR, LICENSING AND

REGULATIONDO NOT WRITE IN THIS SPACE

BOARD FOR PROFESSIONAL ENGINEERSOFFICE RECORD

500 N. CALVERT STREET – ROOM 308 Received______

BALTIMORE, MARYLAND 21202-3651App. No. ______

410-230-6322By: ______

Fee: CK __ MO __

MARYLAND BOARD FOR PROFESSIONAL ENGINEERS
FUNDAMENTALS OF ENGINEERING (EIT)
OCTOBER 29, 2005 RE-EXAMINATION APPLICATION
Filing Deadline: AUGUST 30, 2005 (must be received no later than 5:00 p.m.)
PLEASE NOTE:
  • DO NOT USE THIS FORM UNLESS YOU HAVE BEEN PREVIOUSLY APPROVED TO SIT FOR THE EIT EXAMINATION BY THE MARYLAND BOARD FOR PROFESSIONAL ENGINEERS.
  • DO NOT USE THIS FORM IF YOU HAVE FAILED THE EIT EXAM THREE TIMES. BY LAW YOU MUST WAIT AT LEAST TWO YEARS AND RE-APPLY AS A FIRST TIME APPLICANT.
  • INCOMPLETE APPLICATIONS WILL BE RETURNED AND MAY PRECLUDE YOU FROM SITTING FOR THE UPCOMING EIT EXAMINATION. READ AND FOLLOW DIRECTIONS COMPLETELY
The Fee for the examination is $110.00 including $50 examination cost & non-refundable $60 test service fee. Make your check or money order payable to DLLR-PE and note EIT on the memo line.. NOTE: The examination site is the Timonium Fairgrounds. For directions to the site and other examination related information go to: .
TYPE OR PRINT
1.
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LAST NAME &SR., JR., ETC.
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FIRST / MIDDLE
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FORMER/MAIDEN NAME
2.
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STREET ADDRESS
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CITY
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STATE / ZIP/POSTAL CODE / COUNTRY
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INTERNET E-MAIL ADDRESS
––––– / –––––
BUSINESS TELEPHONE NUMBER / HOME TELEPHONE NUMBER
3. Birth Date / –––– / -- / –––– / -- / ––––
NUMERIC MONTH / DATE / FULL YEAR ( Ex. 01-01-1972)
4. U.S. Social Security Number / ––– / -- / –– / -- / ––––
5. Indicate previous sittings in Maryland for the EIT exam by circling.
04/05 10/04 04/04 10/03 4/03 10/02 4/02 10/01 4/01 10/00 4/00 11/99 4/99 Other(s)______

DLLR EIT APP1005 Page 1 of 2
6.THE FOLLOWING QUESTIONS MUST BE ANSWERED IN ACCORDANCE WITH MARYLAND LAW.

YES / NO
1. Have you ever been convicted of a felony or of a misdemeanor related to the practice of engineering in any State or Federal court?.
2. Have you ever been found guilty of misconduct, incompetence, or gross negligence related to the practice of engineering in any
jurisdiction?…………………………………………………………………………………………………………………………………………………………………
3. Have you ever been convicted of or received probation before judgement of any drug offense committed after January 1, 1991?……

If you answered YES to any question(s) 1-3, submit a letter giving complete explanation and a true test copy of the applicable court document(s) and or request the appropriate state licensing board to send a copy of the final order in your case directly to the Maryland Board.

7. / REQUEST FOR SPECIAL ACCOMMODATIONS
SPECIAL ACCOMMODATIONS FALL UNDER TWO CATEGORIES:
1.CANDIDATES WHOSE RELIGIOUS CONVICTIONS PROHIBIT THEM FROM TESTING ON THE REGULARLY SCHEDULED EXAM DATE; AND
2.INDIVIDUALS WHO HAVE A DOCUMENTED DISABILITY WITHIN THE MEANING OF THE AMERICANS WITH DISABILITIES ACT (ADA) MAY REQUEST SPECIAL ACCOMMODATIONS SUCH AS EXTENDED TESTING TIME OR EXTRA BREAKS.
REQUESTS FOR SPECIAL TESTING ACCOMMODATIONS MUST BE REVIEWED AND APPROVED BY NCEES AND MUST BE RECEIVED BY THEM NO LATER THAN 60 DAYS PRIOR TO THE EXAM ADMINISTRATION.
THE NCEES DOCUMENT GUIDELINES FOR REQUESTING RELIGIOUS AND ADA ACCOMMODATIONS EXPLAINS THE REQUIREMENTS FOR TAKING AN NCEES EXAM WITH SPECIAL ACCOMMODATIONS. FOR ADDITIONAL INFORMATION, GO ONLINE TO THE NCEES HOME PAGE, UNDER THE “EXAMS” HEADING TO FIND THE GUIDELINES.
IF YOU ARE REQUESTING SPECIAL TESTING ACCOMMODATIONS, SEND THE ORIGINAL DOCUMENTS TO NCEES AND SEND A COPY TO THE MARYLAND BOARD, ATTN: LINDA L. RHEW, EXAM COORDINATOR, 500 N. CALVERT STREET, ROOM 308, BALTIMORE, MD 21202.
PLEASE CHECK THE SPECIAL TESTING ACCOMMODATION CATEGORY YOU ARE REQUESTING:
RELIGIOUSADA
8.I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION HEREIN IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
Signature / Date

IMPORTANT INFORMATION

  • Keep a completed copy of this application for your records.
  • Mail your application with your check/money order to the Board address on the top of page one of this application.
  • If your application is incomplete in any way when received by the State Board, it will be returned and you may not be eligible for this examination.
  • Any supporting documentation must be received by the State Board by the filing deadline noted on Page 1.
  • You will receive pre-examination information and your scheduling notice approximately 2 weeks prior to the examination. If you don’t receive them by that time, please contact the Board’s Office by e-mail at: . Make sure you state that you are an EIT exam candidate.
  • EXAMINATION RESULTS WILL BE MAILED WITHIN 120 DAYS OF THE EXAM DATE. IF YOU MOVE IN THE INTERIM, NOTIFY THE STATE BOARD VIA THE E-MAIL ADDRESS

DLLR EIT APP1005 Page 2 of 2

PE EIT1005 (ONLINE)(1005)