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Preview - Ohio 4011 D Form
OHIO’S STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS BOARD USE ONLY |
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renewal Application |
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reMINDer! For faster license renewal, renew online at www.peps.ohio.gov.
DO NOt SUBMIt application if continuing professional development require- ments are not complete in accordance with section 4733.151 of the Ohio R.C.
NAMe AND ADDreSS reQUIreD
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P.e. AND P.S. NUMBerS reQUIreD |
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$80.00 DUe NOW |
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AMOUNT DUE After 12/31/2011: $120.00 |
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Make your check or money order payable in U.S. |
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funds to treasurer, State of Ohio. |
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NAMe cHANGe AND/Or cHANGe Of ADDreSS ONLy
NAME CHANGE reQUIreS LeGAL DOcUMeNtAtION
ADDRESS
ADDRESS
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OHIO COUNTY reQUIreD If OHIO ADDreSS
I do not plan to renew at this time.
IMPOrtANt — DO NOt USe tHIS
fOrM fOr reINStAteMeNt!
this application cANNOt be used for reinstatement of a professional license. It is to be used for
P.E., P.S. renewals only. Email the Board, at pes.board@ pes.ohio.gov, for reinstatement instructions.
DO NOt SUBMIt copies of continuing professional development information with this application.
yeS NO I certify that I have completed 15 continuing professional development hours in accordance with section 4733.151
of the Ohio Revised Code
If you answered NO to this question, DO NOt submit this renewal application.
FOR MORE INFORMATION REGARDING THE CPD REQUIREMENT, CPD AUDIT, AND DOWNLOADING CPD ACTIVITY LOGS, VISIT OUR WEBSITE AT www.peps.ohio.gov.
yeS NO Since your last renewal have you been convicted of or pleaded guilty to any felony or crime involving moral turpitude or had your registration revoked, voluntarily surrendered or suspended by another jurisdiction? If yeS, please give date, type of conviction, court of conviction, case number, and explanation.
ATTACH SEPARATE SHEET IF NEEDED
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I certIfy that this is a properly completed and accurate license renewal application which I am submitting to the state of Ohio’s State Board of Registration for Professional Engineers and Surveyors. I have not omitted any requested information. I
understand that my renewal is contingent upon satisfactory completion of all requirements. I further understand that any person who knowingly makes false statements on the renewal application is guilty of falsiication under section 4733.20 of the Ohio
Revised Code, and subject to penalties under law.
Applicant Signature
STATE BOARD OF REGISTRATION FOR PROFESSIONAL ENGINEERS AND SURVEYORS
50 W BROAD ST STE 1820 COLUMBUS OH
Date Signed
Make check or money order payable in U.S. funds to treasurer, State of Ohio. Cash is not accepted. for credit card payment, renew online. Send completed, signed, and dated application and fee; postmarked no later than 12/31/2011; to the Board address at left.
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Document Properties
| Fact Name | Details |
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| Form Purpose | The Ohio 4011 D form is used for the renewal of Dual Professional Engineer (P.E.) and Professional Surveyor (P.S.) licenses for the 2012-2013 period. |
| Governing Law | This form is governed by Section 4733.151 of the Ohio Revised Code. |
| Application Fee | The renewal fee is $80.00 if submitted by the deadline. After December 31, 2011, the fee increases to $120.00. |
| Continuing Education Requirement | Applicants must complete 15 continuing professional development hours to qualify for renewal, as mandated by Ohio law. |
| Submission Instructions | Completed applications must be postmarked no later than December 31, 2011, and sent to the State Board of Registration for Professional Engineers and Surveyors. |
| Legal Documentation for Name Change | Any name change requires legal documentation to be submitted with the application. |
Documents used along the form
The Ohio 4011 D form is a crucial document for professionals seeking to renew their engineering or surveying licenses in Ohio. However, it is often accompanied by several other forms and documents that facilitate the renewal process or address specific situations. Understanding these additional documents can help ensure a smooth renewal experience.
- Continuing Professional Development (CPD) Log: This document tracks the professional development hours that licensees must complete to maintain their licenses. It includes details of the courses, workshops, or seminars attended and is essential for demonstrating compliance with state requirements.
- Change of Address Form: If a licensee has moved since their last renewal, this form is necessary to update their contact information with the State Board. Keeping this information current is vital for receiving important communications regarding licensing status.
- Transfer-on-Death Deed form: This crucial document allows property owners to transfer their real estate to designated beneficiaries upon their death, ensuring a straightforward transfer process. For more information, please refer to the Transfer-on-Death Deed form.
- Name Change Documentation: When a licensee changes their name, they must provide legal documentation, such as a marriage certificate or court order, to support the change. This ensures that the license reflects the individual's current legal name.
- Reinstatement Application: If a license has lapsed or been revoked, this separate application is required to seek reinstatement. It involves a different set of criteria and should not be confused with the renewal process.
- Verification of Employment Form: Some licensees may need to provide proof of employment in their field as part of the renewal process. This form confirms that the individual is actively engaged in professional practice, which may be a requirement for renewal.
Being aware of these additional forms and documents can significantly ease the renewal process for engineers and surveyors in Ohio. Each document serves a specific purpose and helps maintain the integrity of the licensing system, ensuring that all professionals meet the necessary standards to practice in their fields.
Guidelines on Filling in Ohio 4011 D
Filling out the Ohio 4011 D form is an important step in maintaining your professional license. After you complete the form, you will submit it along with your payment to the State Board of Registration for Professional Engineers and Surveyors. Make sure to follow the steps carefully to ensure your application is processed smoothly.
- Gather your personal information, including your name, address, and P.E. and P.S. license numbers.
- Fill in your name and address in the designated fields on the form.
- Indicate the amount due. If you are submitting after December 31, 2011, the amount will be $120.00; otherwise, it is $80.00.
- Make your payment by check or money order, payable to the Treasurer, State of Ohio. Remember, cash is not accepted.
- If applicable, fill in your new name or address and provide legal documentation for a name change.
- Indicate whether you plan to renew your license. If you do not plan to renew, check the appropriate box.
- Confirm that you have completed the required 15 continuing professional development hours or indicate your exemption if you were registered in 2011.
- Answer the question regarding any felony convictions or license suspensions since your last renewal. If applicable, provide details on a separate sheet.
- Sign and date the application to certify that all information is accurate and complete.
- Mail the completed application and payment to the State Board of Registration for Professional Engineers and Surveyors at the address provided on the form. Ensure it is postmarked no later than December 31, 2011.
Common mistakes
Filling out the Ohio 4011 D form can be straightforward, but there are common mistakes that applicants often make. One significant error is failing to provide complete and accurate information. Every section of the form requires specific details, including your name, address, and license numbers. Omitting any of this information can lead to delays in processing your application.
Another frequent mistake is neglecting the continuing professional development (CPD) requirements. Applicants must certify that they have completed the required 15 CPD hours or indicate their exemption. If you do not meet these requirements, submitting the application will only result in rejection. It is essential to double-check that you have met the criteria before proceeding.
Many people also overlook the payment details. The form specifies an amount due, which changes after the deadline. Submitting the wrong fee or payment method can cause additional complications. Make sure to include a check or money order made out to the Treasurer, State of Ohio, and confirm the correct amount based on the postmark date of your application.
In addition, some applicants mistakenly use the renewal form for reinstatement. The Ohio 4011 D form is strictly for license renewal and cannot be used if your license has lapsed or been revoked. If you find yourself in this situation, reach out to the Board for specific reinstatement instructions instead of submitting the renewal form.
Finally, applicants sometimes fail to sign and date the application. This step is crucial, as submitting an unsigned form can lead to automatic rejection. Ensure that you review the entire application for completeness, including your signature, before mailing it to the Board. Taking the time to avoid these common pitfalls can facilitate a smoother renewal process.
FAQ
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What is the purpose of the Ohio 4011 D form?
The Ohio 4011 D form is specifically designed for the renewal of dual Professional Engineer (P.E.) and Professional Surveyor (P.S.) licenses in Ohio. It is essential for licensed professionals to submit this form to maintain their active status. The form ensures that all necessary information is collected, including proof of continuing professional development, which is a requirement for renewal.
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What are the fees associated with the Ohio 4011 D form?
When renewing your license using the Ohio 4011 D form, the fee is $80. However, if the application is submitted after the deadline of December 31, 2011, the fee increases to $120. It's important to submit your payment in U.S. funds via check or money order made out to the Treasurer, State of Ohio. Keep in mind that cash is not accepted, and online renewal is available for credit card payments.
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What happens if I do not meet the continuing professional development requirements?
If you have not completed the required 15 hours of continuing professional development, you should not submit the Ohio 4011 D form. Instead, it is crucial to fulfill these requirements as outlined in section 4733.151 of the Ohio Revised Code before attempting to renew your license. Failure to meet these requirements may result in the denial of your renewal application.
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Can I use the Ohio 4011 D form for reinstatement of my license?
No, the Ohio 4011 D form cannot be used for the reinstatement of a professional license. This form is strictly for the renewal of existing licenses for the 2012-2013 period. If you need to reinstate your license, you must contact the Ohio State Board of Registration for Professional Engineers and Surveyors for specific instructions on the reinstatement process.