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Update Your Contact Information Online
Update Your Contact Information Online
Completion of this form will generate an email message to board staff who will respond with a confirmation once the requested address information has been updated. This form may be used by all applicants, licensees, and those responsible for Certificates of Authorization for business entities. If you do
not
receive an email confirmation within three business days then you may wish to submit another form or e-mail
ksbtpadmin@ks.gov
for assistance.
You may also update your contact information by submitting a paper form
navigating to the Forms > Individuals tab.
Required fields are marked with an asterik (*).
Your Information
* Name:
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Please enter your legal name. If you are submitting changes for a Certificate of Authorization please also list your title within the business, e.g. "Principal" or "Office Manager."
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* Profession:
Applicant or Unlicensed Person
Architect
Professional Engineer
Landscape Architect
Professional Geologist
Professional Surveyor
Certificate of Authorization (Business Entity)
* License Number:
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If none, please enter NONE
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*E-mail Address
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*Daytime Phone Number:
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Select a choice
Cell
Work
Home
Secondary Phone Number:
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Work
Home
* Preferred Mailing Address:
Home
Business
New Home Address (if applicable)
Street:
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City:
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State:
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Zip Code:
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New Business Address (if applicable)
Company/Business Name:
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Street:
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City:
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State:
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Zip Code:
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The licensee shall notify the board in writing of any change of address within 30 days after the date of such change. (K.S.A 74-7025)
By submitting this form I certify under penalty of perjury under the laws of the State of Kansas that the information provided on this form is true and correct and that I am licensed to practice in the State of Kansas.