Architect License Application - Nebraska Board of Engineers and ...

Mail to: PO Box 95165 Delivery: 215 Centennial Mall S, Suite 400 Phone: 402-471-2021 

Lincoln, NE 68509 Lincoln, NE 68508 Fax: 402-471-0787 

Questions? Contact us at NBEA.office@nebraska.gov or www.ea.ne.gov Filing Fee: $150.00 

APPLICATION FOR LICENSURE OF AN ARCHITECT 

All applicants must complete this application. Read instructions and check all items carefully. Provide all information requested. 

Do not substitute a resume or other synopsis for any part of this application form. Your attention to these details will make it 

possible for the Board’s staff to process your application without undue delay. Please print all information. 

NOTE: If you have an NCARB certificate, and made a request to NCARB to have it transmitted to the Nebraska Board, complete 

Section I and proceed to Section V. You do not need to fill out Sections II, III, IV or submit a verification form. 

SECTION I: GENERAL INFORMATION 

1. _________________________________________________________________________________________________________ 

Full Legal Name (Including middle name) 

2. 

Last 4 digits of your Social Security Number 

3. Previously registered in Nebraska? No Yes 

License Number 

If you are requesting reinstatement, you must complete a Reinstatement Affidavit. All applicants with inactive licenses must also submit delinquent continuing 

education of 24 hours; of those, at least 16 must address the safeguarding of life, health, and property (use the CEU Log on our website). 

4. Do you have an NCARB certificate? No Yes NCARB Certificate Number: 

5. Preferred Address for all official Board Correspondence: Business Residence 

Firm Name (if business) 

Mailing Address 

City, State, Zip Code 

Email Address 

Telephone 

ext 

Alternate Telephone 

ext 

Fax 

SECTION II: EDUCATION 

Enter the name and location of the college or university, the time spent, the year of graduation, and type of degree received. Applicants with degrees obtained outside 

the U.S. must have their degrees evaluated by NAAB or a Board-approved evaluator. Please visit www.naab.org or email info@naab.org for more information. Their 

evaluation is to be submitted directly to the Nebraska Board. 

Name of Institution, Location 

(City, State) 

Enrollment Date Date Graduated Degree Received 

Mo. Yr. Mo. Yr. (BS, MS, etc.) 

Major 

FORM: #30.01-D (29-Jun-12) Page 1 of 4 

BOARD USE: Fee Paid Receipt # Date

SECTION III: LICENSURE INFORMATION 




If you have licenses in other states, you may attach copies of them to this application. You must have your first and/or current state of licensure forward verification of 

your license to the Nebraska Board directly. Use the Verification of Licensure and Examination of an Architect attached to the end of this application. 

1. Architect (ARE) Exam 

State: Date Final Exam Passed: License #: 

2. State of First License (If different from Question 1) 

State: Date Issued: License #: 

3. Current License 

Expiration Date: License #: 

SECTION IV: REFERENCES 

List the names and addresses of five people unrelated to you to whom you reported or with whom you have been professionally associated. For licensure as an architect 

by experience (15 or more years licensed experience in another jurisdiction), an applicant must submit five licensed architects. For all other applications, three shall be 

licensed architects having personal knowledge of your architectural experience. No member of the Nebraska Board will be accepted as a reference. 

1. 4. 

Name 

Name 

Address 

Address 

Telephone E-mail Telephone Email 

License number and State, if Licensed Architect 


2. 5. 

Name 

Name 

Address 

Address 

Telephone Email Telephone Email 



3. 

Name 

Address 

Telephone 

Email 


FORM: #30.01-D (29-Jun-12) Page 2 of 4

SECTION V: PROFESSIONAL EXPERIENCE 




Record your complete work history, beginning after college graduation and concluding with your present employment. You must account for the entire time period 

from graduation until now, including periods of unemployment, volunteer work, non-engineering work, and military experience. If you have an NCARB record, provide 

all work history not included in your record, and your current at a minimum. Attach additional copies of this section if needed. 

Employment Dates 

Month/Year 

From 

10/2004 

To 

7/2008 

From 

Title of position held, name and address of employer and a brief summary of the 

architectural work performed. Make statement brief and concise. 

Architect, Smith White & Associates 

1620 Midtown Place 

Raleigh, NC 27609 

EXAMPLE 

Responsible for daily operations of design concept & development and 

construction administration for firm that specializes in architecture, master 

planning and urban design for a multitude of project types. Project types 

include retail, institutional, and mixed-use developments. 

Name, telephone number, address, and e-mail of 

someone familiar with each work period, preferably 

the person to whom applicant reported. 

John Doe 

1620 Midtown Place 

Raleigh, NC 27609 

919-555-3746 

jdoe@smithwhite.org 

EXAMPLE 

To 

From 

To 

From 

To 

From 

To 





SECTION VI: AFFIDAVIT 

1. Have you solicited architectural work or represented yourself as an architect in Nebraska prior 

to having been licensed? 

______ yes 

______ no 

2. Have you been disciplined by any occupational licensing board? ______ yes ______ no 

3. Are you currently under investigation by any occupational licensing board? ______ yes ______ no 

4. Has your architectural license been denied, suspended or revoked in any jurisdiction? ______ yes ______ no 

5. Have you surrendered or allowed an architectural license to lapse in any jurisdiction due to any 

action pending or threatened? 

6. Have you signed any legal document that settles a dispute or charges against you brought by a 

Registration Board or a court of law? 

7. Have you been found by a court of law or Registration Board to have violated the architectural 

licensure laws or the professional/occupational laws of any jurisdiction? 

8. Have you entered into a negotiated settlement with regard to professional or occupational 

licensure laws? 

9. Have you ever been convicted of any crime involving moral turpitude, fraud, deceit, or 

misrepresentation or been convicted of any crime other than a minor traffic violation in any 

jurisdiction? 

______ yes 

______ yes 

______ yes 

______ yes 

______ yes 

______ no 

______ no 

______ no 

______ no 

______ no 

10. Are there any criminal charges now pending against you? ______ yes ______ no 

If the answer to any of these questions is “yes”, please attach a detailed explanatory statement. 

For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, I attest as follows: 

I am a citizen of the United States, OR 

I am a qualified alien under the federal Immigration and Nationality Act, my immigration status and alien number are 

__________________________________________, and I have enclosed a copy of my USCIS documentation. 

I hereby attest that my response and the information provided on this form and any related application for public benefits are true, 

complete, and accurate and I understand that this information may be used to verify my lawful presence in the United States. 

I will not represent myself as an architect or offer to perform architectural services in the State of Nebraska until this application is 

approved and an architect’s license has been granted by the Nebraska Board of Engineers and Architects. 

Unless my firm holds a current Certificate of Authorization, no agent of my firm will solicit, offer, or contract to perform architectural 

services in Nebraska until the application process is completed and an architect’s license has been granted by the Board. 

I have read the Nebraska Engineers and Architects Regulation Act. 

Signature of Applicant 

A short law examination covering the Engineers and Architects Regulation Act must be passed before licensure. The 

examination will be mailed or faxed to you upon receipt of the completed application. 

In the event that your check is returned unpaid for insufficient or uncollected funds, we may re-present your check 

electronically. In the ordinary course of business, your check will not be provided to you with your statement. 

Date 




Questions? Contact us at NBEA.office@nebraska.gov or www.ea.ne.gov 

VERIFICATION OF LICENSURE AND EXAMINATION OF AN ARCHITECT 

Applicants should complete only Section I of this form. Forward this form to the appropriate state registration board to be completed 

and returned to the Nebraska Board. This form can be found online at http://www.ea.ne.gov/verification.html 

FROM (STATE BOARD NAME): 

DATE: 

ADDRESS: 

FILE NO.: 

SECTION I: APPLICANT INFORMATION 

NAME DATE OF BIRTH: LAST 4 DIGITS OF SSN: 

ADDRESS (STREET, CITY, STATE, ZIP) 

SECTION II: VERIFICATION OF LICENSURE OR EXAMINATION 

Certificate or License # Date Issued Valid Until 

1. THE ABOVE-NAMED PERSON IS OR WAS 

REGISTERED AS AN ARCHITECT: 

2. EDUCATION AND EXPERIENCE 

A. COLLEGE/UNIVERSITY: DEGREE: MONTH/YEAR GRADUATED: 

B. INTERN DEVELOPMENT PROGRAM REQUIREMENT COMPLETED?: □ Yes □ No 

MONTH/YEAR COMPLETED: 

C. OTHER: 

3. DENIALS, INVESGITATIONS, AND/OR COMPLAINTS: 

A. Has the above-named individual ever been denied registration in your state? (if yes, please give details on reverse side.) □ Yes □ No 

B. Has a complaint been filed or has formal disciplinary action been taken against the above-named individual? □ Yes □ No 

(If Yes, please give details in REMARKS or on reverse) 

4. REMARKS: 

5. VERIFIED BY: 

BY: 

BOARD SEAL 

TITLE: 

DATE: 

IF A FEE IS REQUIRED, PLEASE NOTIFY APPLICANT 

BUT DO NOT DELAY THE PROCESSING OF THIS FORM. 

FORM: #30.01-D (Verification) (11-Dec-09) Page 1 of 2



Questions? Contact us at NBEA.office@nebraska.gov or www.ea.ne.gov 

REPORT OF WRITTEN EXAMINATION 

EXAMINATION SYLLABUS (1954-1975) Hours Grade Minimum Date Passed 

A. Education & Experience 

B. Personal Audience 

C. History & Theory of Architecture 3 

D. Site Planning 5 

E. Architectural Design 12 

F. Building Construction 3 

G. Structural Design 5 

H. Professional Administration 3 

I. Building Equipment 5 

EQUIVALENCY EXAMINATION (June 1973 – June 1976) Hours Grade Date Passed 

I. Architectural Theory 2 

II. Construction Theory & Practice 8 

III. Architectural Design/Site Planning 10 

QUALIFYING TEST (June 1977 – June 1982) Hours Grade Date Passed 

A. Architectural History 2 

B. Structural Technology 3 

C. Materials & Methods of Construction 2 

D. Environmental Control Systems 2 

E.1 Principles of Site Planning & Arch. Design (1977-78, multiple choice) 1 

E.2 Principles of Site Planning & Arch. Design (1977-78, design problems) 11 

PROFESSIONAL EXAMINATION – SECTION A (June 1979 – June 1982) Hours Grade Date Passed 

Design/Site Test 12 

PROFESSIONAL EXAMINATION (December 1973 – December 1978) 

SECTION B (1979 – 1982) 

Part I Environmental Analysis 

Part II Architectural Planning 

Part III Design and Technology 

Part IV Construction 

Hours Grade Date Passed 

ARCHITECT REGISTRATION EXAMINATION (ARE) 

(1983-1987) Grade Date Passed (1988-1996) Grade Date Passed (1997-2009) Grade Date Passed ARE 4.0 (2008-) Grade Date Passed 

A - Pre-Design A - Pre-Design PD Program 

B - Site Design 

B - Site Design/ 

Written 

B - Site Design/ 

Graphic 

SP 

Planning and 

Practice 

Site Planning & 

Design 

C - Building Design C - Building Design BP Bldg Design & 

Construction 

D - General Structure 

BT 

Systems 

F - Long Span 

D/F - General & 

Schematic 

GS 

Structure 

Long Span 

Design 

E - Lateral Forces E - Lateral Forces LF 

Structural 

Systems 

G - Mech/Electrical G - Mech/Electrical ME Building Systems 

H - Materials/ 

H - Materials Methods MM Construction 

Methods 

Documents & 

CD 

Services 

I - Construction 

Documents 

I - Construction 

Documents 

FORM: #30.01-D (Verification) (11-Dec-09) Page 2 of 2

Architect License Application - Nebraska Board of Engineers and ...

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