Request for Verifi cation
[Pages:2]670 Hawthorne Ave. SE Ste 220 Salem OR 97301
BOARD OF EXAMINERS FOR ENGINEERING & LAND SURVEYING
Request for Verification Instructions Page 1 of 1
Phone: 503-362-2666 Email: @osbeels. Web: osbeels
Instructions for Filling Out Request for Verification
NOTE: All fees must be paid in full prior to processing the Request for Verification.
Who should fill out the Request for Verification form?
Individuals certified as an engineering intern (EI) and/or land surveying intern (LSI), a professional engineer (PE), professional land surveyor (PLS), Certified Water Right Examiner (CWRE), and/or registered professional photogrammetrist (RPP) in the State of Oregon who wish to send examination history and registration information to another state's licensing board, NCEES, employer, other entity, or for personal records.
There are three methods of transmitting verification:
? Digital submission to state licensing boards via the National Council of Examiners for Engineering and Surveying (NCEES) License/Exam Verification system. Note: you must first request verification of your license and examination information through the NCEES License/Exam Verification system ().
? Submission of a stamped paper document to a State/Territory licensing board that does not participate in the NCEES License/Exam Verification system: AZ, MT, NY, PA, SD, VT, WI, Guam, Puerto Rico.
? Submission of a stamped paper document to another entity.
How requests are processed
Requests will be processed according to the date received. Be sure to include full payment for each recipient. Fees are located in Oregon Administrative Rule 820-080-0010.
General Instructions
Step 1 Step 2:
Send form and payment to the Oregon State Board of Examiners for Engineering & Land Surveying: OSBEELS 670 Hawthorne Avenue, SE Suite 220 Salem, OR 97301
If the recipient has not received a verification from the OSBEELS within 30 days of submittal, contact us.
You may also email this PDF to us filled out. @osbeels.
OREGON STATE BOARD OF EXAMINERS FOR ENGINEERING & LAND SURVEYING Request for Verification, revised 2021
503-362-2666 @osbeels.
BOARD OF EXAMINERS FOR ENGINEERING & LAND SURVEYING
OFFICIAL USE ONLY ID NUMBER
OFFICIAL USE ONLY DATE RECEIVED
OFFICIAL USE ONLY DATE PAID
Request for Verification
Individual Information
First Name
Middle Name or Initial
Last Name
Home Address (include any unit number)
Home Phone
City
State / Province
Zip / Postal Code Home Email
Select one:
I have requested verification of my license and examination information through MyNCEES account State/Territory not participating in NCEES system: AZ MT NY PA SD VT WI Guam Puerto Rico Send my verification to another entity
Entity Name: Entity Address:
Select payment method (select one)
Check or Money Order (payable to OSBEELS)
Debit or Credit Card (Visa, Mastercard, Discover, AmEx)
Card Number
Exp. Date
Amount Enclosed: Total charged: Security Code*
Verification Fee: $15
Billing Zip
Signature (serves as payment authorization)
Date (M/D/Y)
* Debit or Credit Card Security Codes
If submitting a payment to the OSBEELS for fees by debit or credit card, please provide the security code. These codes are a security feature that appears on the back of most Visa, MasterCard, and Discover cards, and on the front of American Express cards. This code is a three or four-digit number which provides a cryptographic check on the information embossed on the card.
American Express Card Users: Look for the 4-digit code printed on the front of the card just above and to the right of the main card number. This 4-digit code is the card security code. Visa, MasterCard, and Discover Card Users: Flip the card over and look at the signature box. A special 3-digit code will be located in the signature box. This 3-digit code is the card security code.
OREGON STATE BOARD OF EXAMINERS FOR ENGINEERING & LAND SURVEYING Request for Verification, revised 2021
503-362-2666 @osbeels.
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