Nevada Board of Professional Engineers and Land Surveyors
1755 E Plumb Lane, Suite 135 Reno, NV 89502
Required for renewal submitted after Date Due. Late fees are due for Active & Inactive
No fees are due to retire or withdraw a license. You must sign at the bottom of
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)
I do have documentation in my files. Do not send PDH documentation unless
I did not meet the 30 PDH continuing education requirement for this period.
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.
This is my first renewal (licensed less than 2 years).
I had a serious illness during this period.
I served more than 120 days on active military duty during this period.
I worked outside the United States for a minimum of 120 days this period.
Mark selections and sign the signature block. [ Renewals will not be accepted
unless the forms are properly completed and signed. ]
NO, I have not been disciplined by any licensing jurisdiction within the past two years.
YES, I have been disciplined by any licensing jurisdiction within the past two years.
( If Yes, describe in full in the area below and submit with this form. )
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.
I am not subject to a court order for payment of child support.
I am subject to a court order for payment of child support for one or more children,
and I am in compliance with the order or a plan approved by the district attorney or other
public agency enforcing the order for the payment of the amount owed pursuant to the
I am subject to a court order for the support of one or more children, and I am not in compliance with the order or a plan approved by the district attorney or other public agency enforcing the order for the payment of the amount owed pursuant to the order
Please go to www.nvsos.gov/index.aspx?page=267 for information on the
Nevada Secretary of State’s business license requirements.
Yes, I have a Nevada State Business License. (If checked enter the license number below)
Nevada State Business License Number:
No, I do not have a Nevada State Business License.
This statement is to confirm my request to Retire or Withdraw my Nevada