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Professional License Renewal


Nevada Board of Professional Engineers and Land Surveyors 1755 E Plumb Lane, Suite 135 Reno, NV 89502



1. License Detail :

License # :
Please enter license# including leading zero (s) for renewal.
License period from : to :
Due Date :
Discipline :

2. FEES :

Required for renewal submitted after Date Due. Late fees are due for Active & Inactive renewals.

No fees are due to retire or withdraw a license. You must sign at the bottom of the form.




3. To verify our records, please make sure that your CURRENT Home Address and Employer Information mentioned below are correct

My "Preferred Mailing Address" is :          
Residence Address
Employer Name & Address

(Company Name; City; State; Zip)

4. Statement of Compliance for Professional Development Hours (PDHs) [NAC 625.430]

You must check Active or Inactive below. License may become Inactive if PDHs are not reported correctly.

I have complied with the Board’s continuing education requirement. (30 PDHs minimum)
Nevada residents must enter their PDHs.

I do have documentation in my files. Do not send PDH documentation unless requested.


Write PDH total in the "B" box below

PDH carryover from last renewal period (15 maximum) + PDH completed for current period = Total PDH = Previous Carryover + current (30 minimum) PDH carryover to next period excess of 30 (15 maximum)
A B A+B=C C

I have complied with the continuing education requirements in another state and that state's continuing education requirements are substantially equivalent to those in Nevada.

I did not meet the 30 PDH continuing education requirement for this period.

  • If you choose Inactive you must answer all questions, sign the affidavit at the bottom of the form, and submit payment shown in "Amount Due".

I did not acquire the 30 PDHs of continuing education because of the following

exemption pursuant to NAC 625.440. Send documentation, must be approved by the Board.


5. Disciplinary & Child Support Declarations:

Mark selections and sign the signature block. [ Renewals will not be accepted unless the forms are properly completed and signed. ]

    DISCIPLINARY DECLARATION

    ( If Yes, describe in full in the area below and submit with this form. )

    CHILD SUPPORT DECLARATION

    In compliance with the Federal Welfare Reform Act and the Nevada State Welfare Division, the 1997 session of the Nevada Legislature enacted NRS 625.387. This requires that all professional and occupational licensing agencies add specific questions regarding child support to all applications for new licenses and license renewals.


6. Do you have a Nevada State Business License?

    (If checked enter the license number below)


6. Are you a military veteran or currently serving in the US military?


Affidavit (All ACTIVE and INACTIVE licensees must sign here)


  • Pursuant to NAC 625.430, I have reported only Professional Development Hours that are related to my practice and have judged them to meet the Board’s requirements. I am aware that my report may be audited by the Board and I will need documentation to support the PDHs reported – OR – I have chosen "Inactive" status because I have not obtained the required PDHs
  • I certify with my signature that all information presented in this report is true and correct.

Signature

Date


Sign here if you selected "Retired or Withdraw" status:

    This statement is to confirm my request to Retire or Withdraw my Nevada license


Signature

Date