Professional Geology Form 20T

Professional Geology Form 20T

Certification of Anticipated Completion of a Professionally Registered Program

(Licensure-Qualifying) in Geological Sciences

The University of the State of New York The State Education Department Office of the Professions

Division of Professional Licensing Services op.

(Name of college or university)

Form 20T can be used for certification of anticipated completion of a curriculum specifically registered by the New York State Education Department as qualifying for admission to the ASBOG Fundamentals of Geology licensing examination. Programs that meet this criteria are baccalaureate programs in "Geologic Sciences" which have been evaluated and approved as licensure qualifying by the New York State Education Department. In accordance with the Regulations of the Commissioner of Education, students who have completed three years and are within twenty (20) credits of graduation in a program in "Geologic Sciences" qualified by the New York State Education Department are eligible to sit for the Fundamentals of Geology licensing examination.

In accordance with Education Law, Article 145, Certificates for "Intern Geologist" will be issued to students upon successful completion of the ASBOG Fundamentals of Geology (FG) licensing examination and receipt of Form 20F verifying the student has successfully completed the licensure-qualifying program available at .

Name of Candidate

Date of Birth month/day/year

Social Security Number

Degree and Exact Title of Registered Program

Professional Geology Form 20T, Page 1 of 4, Rev. 10/18

Name of Candidate

Date of Birth month/day/year

Social Security Number

Degree and Exact Title of Registered Program

Professional Geology Form 20T, Page 2 of 4, Rev. 10/18

Name of Candidate

Date of Birth month/day/year

Social Security Number

Degree and Exact Title of Registered Program

Professional Geology Form 20T, Page 3 of 4, Rev. 10/18

Name of Candidate

Date of Birth month/day/year

Social Security Number

Degree and Exact Title of Registered Program

This certifies that each candidate listed above has graduated from a program in "Geological Sciences" qualified by the NYSED as licensure-qualifying.

In witness whereof, I hereunto set my hand and the seal on this

day of

20

.

Signature of Registrar Signature of Department Chair or Dean of Geology Name of School Address

Seal

Telephone

Fax

Email

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services, Professional Geology Unit, 89 Washington Avenue, Albany, NY 12234-1000.

Professional Geology Form 20T, Page 4 of 4, Rev. 10/18

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