Register | CCIDC, Inc.

Candidate Legal Name

First

Middle

Last

Candidate Alternate Name (If Applicable)

If you go by a name other than your legal name and would like your paperwork to reflect it, please provide that alternate name here.

Address

Address Line 1

Address Line 2

City

State

Zip Code

Candidate Phone

Candidate Email

Have you completed either 40 Core Units or 5 years Diversified Design Experience? (Check All That Apply)

40 (+) Core Units
5 (+) Years Diversified Design Experience
I have not completed either of the above

Core Units: Total Combined Coursework Units in the Following Categories (General Education Courses Excluded). | Design Experience Including: Preparing complex nonstructural or non-seismic plans that require the skills of a licensed contractor to implement.

Have you completed one of the following national exams? (Check all that apply)

If you have completed one of the exams above, will you be applying for the Commercial Designation?

Yes
No
N/A

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Signature

Clear Signature

I hereby declare that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification

Please submit this form to receive the login credentials needed to complete the online application.