Form DBPR ID1 "Application for Interior Designer Registration by Examination" - Florida

What Is Form DBPR ID1?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR ID1 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR ID1 "Application for Interior Designer Registration by Examination" - Florida

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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Application for Interior Designer Registration by Examination
Form # DBPR ID 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Submit the non-refundable fee of $30. Make check payable to the Florida
Interior Designer
Department of Business and Professional Regulation.
Registration by
 Submit proof of passing the qualified examination prescribed by the
Examination
Council for Interior Design Qualification.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
This application is used by individuals that have taken and passed the qualified examination prescribed
by the Council for Interior Design Qualification or its successor entity or has successfully passed an
equivalent exam as determined by the department. If you are licensed, certified, or registered in another
state, please use the Interior Design Registration by Endorsement Application (ID 4).
Application Instructions
a. Section I-Application Type
Check the box, Interior Design Registration by Examination.
b. Section II- Applicant Information
i.
Fill out each section completely.
ii.
In the Full Legal Name section provide your full legal name as it appears on your license.
Do not use any nicknames or initials. Please list any aliases or prior names in the prior
name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
c. Section III-Examination History
i.
Provide proof of passing the qualified examination prescribed by the Council for Interior
Design Qualification or its successor entity.
d.
Section IV- Background Questions
i.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section V (b) [make
additional copies as necessary] of the application and provide a copy of the arrest
report, copies of the disposition or final order(s), and documentation proving all
sanctions have been served and satisfied. You must supply this documentation
for each occurrence. If you are unable to supply this documentation, a certified
statement from the clerk of court for the relevant jurisdiction stating the status of
records is required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
ii.
Question 2:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and provide a copy of the judgment
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Application for Interior Designer Registration by Examination
Form # DBPR ID 1
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Submit the non-refundable fee of $30. Make check payable to the Florida
Interior Designer
Department of Business and Professional Regulation.
Registration by
 Submit proof of passing the qualified examination prescribed by the
Examination
Council for Interior Design Qualification.
Please mail your completed application, documentation and required fee(s) to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Fl 32399-0783
This application is used by individuals that have taken and passed the qualified examination prescribed
by the Council for Interior Design Qualification or its successor entity or has successfully passed an
equivalent exam as determined by the department. If you are licensed, certified, or registered in another
state, please use the Interior Design Registration by Endorsement Application (ID 4).
Application Instructions
a. Section I-Application Type
Check the box, Interior Design Registration by Examination.
b. Section II- Applicant Information
i.
Fill out each section completely.
ii.
In the Full Legal Name section provide your full legal name as it appears on your license.
Do not use any nicknames or initials. Please list any aliases or prior names in the prior
name information section.
iii.
Provide your mailing address. This will be used for sending correspondence regarding
your application and license.
iv.
Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
c. Section III-Examination History
i.
Provide proof of passing the qualified examination prescribed by the Council for Interior
Design Qualification or its successor entity.
d.
Section IV- Background Questions
i.
Question 1:
(1)
If you answer “yes” to this question, you must complete Section V (b) [make
additional copies as necessary] of the application and provide a copy of the arrest
report, copies of the disposition or final order(s), and documentation proving all
sanctions have been served and satisfied. You must supply this documentation
for each occurrence. If you are unable to supply this documentation, a certified
statement from the clerk of court for the relevant jurisdiction stating the status of
records is required.
(2)
If you are still on probation, you must supply a letter from your probation officer, on
official letterhead, stating the status of your probation.
ii.
Question 2:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and provide a copy of the judgment
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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or decree. You must also supply documentation proving all sanctions have been
served and satisfied, or if not, stating the current status of any proceedings.
iii.
Question 3:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and supply copies of
documentation explaining the denial or pending action.
iv.
Question 4:
(1)
If you answer “yes” to this question, you must complete Section V (c) [make
additional copies as necessary] of the application and supply copies of the order(s)
showing the disciplinary action taken against the license, or documentation showing
the status of the pending action.
e. Section V - Affirmation by Written Declaration
i.
Please read, sign, and date the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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State of Florida
Department of Business and Professional Regulation
Board of Architecture and Interior Design
Application for Interior Designer Registration by Exam
Form # DBPR ID 1
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I- Application Type
CHECK APPLICATION TYPE
 Interior Design Registration by Examination [0203/1030]
Section II – Applicant Information
APPLICANT INFORMATION
Social Security Number*
FULL LEGAL NAME
Last/Surname
First
Middle
Suffix
Birth Date (MM/DD/YYYY)
Gender
/
/
 Male  Female
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Primary Phone Number
Primary E-Mail Address
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
PRIOR NAME INFORMATION
Have you used, been known as, or are currently known by another name (e.g., maiden name or
nickname) or alias other than the name signed to the application? 
Yes
No
If your answer is yes, state name or names used below:
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
Last/Surname
First
Middle
Suffix
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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Section III – Examination History
EXAMINATION HISTORY
Have you previously taken and passed parts of the NCIDQ examination? If yes, what
 Yes
state?
 No
Section IV – Background Questions
BACKGROUND QUESTIONS
1.
 Yes
 No
Have you ever been convicted or found guilty of, or entered a plea of nolo
(If yes, please
contendere or guilty to, regardless of adjudication, a crime in any
complete
jurisdiction, or are you currently under criminal investigation? This
Section V (b))
question applies to any criminal violation of the laws of any municipality,
county, state or nation, including felony, misdemeanor and traffic offenses
(but not parking, speeding, inspection, or traffic signal violations), without
regard to whether you were placed on probation, had adjudication
withheld, were paroled, or pardoned. If you intend to answer “NO”
because you believe those records have been expunged or sealed by
court order pursuant to Section 943.0585 or 943.059, Florida Statutes, or
applicable law of another state, you are responsible for verifying the
expungement or sealing prior to answering "NO." YOUR ANSWER TO
THIS QUESTION MAY BE CHECKED AGAINST LOCAL, STATE AND
FEDERAL RECORDS. FAILURE TO ANSWER THIS QUESTION
ACCURATELY MAY RESULT IN THE DENIAL OR REVOCATION OF
YOUR LICENSE. IF YOU DO NOT FULLY UNDERSTAND THIS
QUESTION, CONSULT WITH AN ATTORNEY OR CONTACT THE
DEPARTMENT.
2.
 Yes
 No
Has any judgment or decree of a court been entered against you in this or
(If yes, please
any other state, province, district, territory, possession or nation, related
complete
to the practice or profession for which you are applying, or is there any
Section V (c))
such case or investigation pending?
3.
 Yes
 No
Have you ever had an application for registration, certification, or
(If yes, please
licensure in Florida or in any other jurisdiction denied, or is there now
complete
pending a proceeding or investigation to deny such an application?
Section V (c))
4.
 Yes
 No
Has any license, registration, or permit to practice any regulated
(If yes, please
profession, occupation, vocation, or business been revoked, annulled,
complete
suspended, relinquished, surrendered, or otherwise disciplined in Florida
Section V (c))
or in any other jurisdiction, or is any such proceeding or investigation now
pending?
If you answered “YES” to any question in questions 1-4 above, please refer to Instructions for detailed
instructions for providing complete explanations, including requirements for submitting supporting legal
documents. Please complete Section V (b) for your response to question 1, and complete Section V (c)
for your response to questions 2 through 4. If you have more than two offenses to document in Section V
(b), or more than one offense to document in Section V (c), attach additional pages as necessary.
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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Section IV (b) – Explanation(s) for Background Question 1
EXPLANATION
Offense
County
State
Penalty/Disposition
Date of Offense (MM/DD/YYYY)
Have all sanctions been satisfied?
/
/
 Yes  No
Description
EXPLANATION
Offense
County
State
Penalty/Disposition
Date of Offense (MM/DD/YYYY)
Have all sanctions been satisfied?
/
/
 Yes  No
Description
Section IV (c) – Explanation(s) for Background Questions 2 through 4
EXPLANATION
State/Jurisdiction
Application Type/License Number
DBPR ID 1 - Application for Interior Designer Registration by Exam
Eff. Date: July 2020
Incorporated by Rule: 61-35.002
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