Free 49856.FH11 - Indiana

SUPPLEMENTAL INFORMATION FOR LAND SURVEYOR & LAND SURVEYING INTERN APPLICATION
State Form 49856 (R / 10-08)

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THIS FORM MUST BE FILED BY APPLICANTS WHO DO NOT HAVE A BACHELORS DEGREE IN A BOARD-APPROVED LAND SURVEYING CURRICULUM. INSTRUCTIONS: 1. Hours means semester credit hours. Please highlight any credits based on quarters. a. Total Math hours must include three (3) hours of calculus or differential equations. b. Total Science hours must include five (5) hours of physics. c. See attached Land Surveyor Education Requirements (01/03/2003 through 01/02/2009) for further information. All courses listed below must have been successfully completed by applicant. If additional space is required, copies may be made of this form.

2. 3.
Name of applicant

NAME OF INSTITUTION

COLLEGE LEVEL MATH COURSE NAME AND NUMBER

HOURS

COLLEGE LEVEL PHYSICAL SCIENCES COURSE NAME AND NUMBER HOURS

COLLEGE LEVEL SURVEYING COURSE NAME AND NUMBER HOURS

TOTAL MATH HOURS
CALCULUS / DIFFERENTIAL EQUATIONS (3 hours required)

0
3 12

TOTAL PHYSICAL SCIENCE HOURS
(5 hours required)

0
5 11

TOTAL SURVEYING HOURS TOTAL SURVEYING HOURS REQUIRED

0
27

SUB TOTAL

SUB TOTAL - PHYSICS

TOTAL MATH HOURS REQUIRED

(Including calculus / differential equations)

TOTAL PHYSICAL SCIENCE HOURS REQUIRED (Including physics)