1) Date of Application: Enter the current date.
2) Application: Select Initial License Application if you do not have a license and are applying for one. Select License Renewal Application if you are renewing your license.
3) HUD License Number: If you are renewing your license, please enter your license number as listed on your certificate and license card.
4) Expiration Date: If you are renewing your license, please enter the current expiration date as listed on your certificate and license card.

Section 1 - Applicant Personal Information
5) Last Name: Enter your last name.
6) First Name: Enter your first name.
7) MI: Enter your middle initial.
8) Date of Birth: Enter your date of birth.
9) Street Address: Enter your street address.
10) City: Enter the city you live in.
11) State: Enter two-letter postal abbreviation of the state you live in.
12) Zip Code: Enter the Zip Code you live in, either in 5 or 9 numeral format.
13) Home Phone: Enter your home phone number including area code.

Section 2 - Applicant Business Information
14) Name of Business Affiliation: Enter the name of your business.
15) Street Address: Enter the street address of your business.
16) City: Enter the city in which your business is located.
17) State: Enter the state in which your business is located.
18) Zip Code: Enter the state in which your business is located.
19) Business Phone: Enter your business' primary contact number including area code.

Section 3 - Required Training for Initial License or Continuing Education for License Renewal
20) Name of HUD-Registered Trainer or Provider of Continuing Education: Enter the name of the trainer/provider of your educational requirements.
21) Brief Description of Course Content: Please provide a concise description of the course's topic(s).
22) Date of Training or Continuing Education: Enter the begin date of your training.
23) Hours Completed: Enter how many hours were spent in the training course.
24) +/-: If need be, use the + button to add an additional line. Use the - button to remove additional lines.

Section 4 - Successful Completion of HUD-administered or HUD-approved Installer Test
25) Date of Test: Enter the date you took the Installer Test.
26) Test Administrator: Enter the name of the person who administered the test.
27) City: Enter the city where you took the test.
28) State: Enter the state where you took the test.
29) Test Score: Please enter your official score on the Installer Test. Please attach a copy of the test score record to this application, available at the bottom of the page.

Section 5 - Proof of Surety Bond or Insurance
30) Name of Insured Person/Company: Enter the name of the company or person for whom the insurance is applicable.
31) Insurance Carrier: Enter the name of the insurance company.
32) Policy/Binder Number: Enter the policy number if insurance; enter the binder number if surety bond.
33) Amount Covered: The amount of insurance coverage.
34) Policy Expiration Date: The date that the insurance policy expires.
35) +/-: Use this to add or remove additional lines as necessary.

Section 6 - Required Experience
36) Waiver Requested: Check this box if you are requesting a waiver on the experience requirements due to retaining a State license or certification. Proceed to Section 7.
37) Areas of Experience: Please choose the most applicable choice(s) from the list. Multiple entries may be chosen by holding down Control/CTRL.
38) Verification of Required Experience: Select the checkboxes that apply.

Section 7 - Other Installation Certificates or Licenses
39) Checkboxes: Select "I DO NOT retain State certification or license to perform installation work" if this is true. Proceed to Section 8. Otherwise, select the other checkbox and proceed to fill out Section 7.
40) State of Issuance: Enter the state which provided the certification or license.
41) License/Certification Number: Enter the state-provided License or Certification number.
42) Current or Expired: Enter whether the license or certification is expired.
43) Suspended, Revoked or Denied: If any of these are true, select YES. Otherwise, select NO.
44) Explanation if Suspended, Revoked or Denied: Please enter a concise explanation of the suspension, revocation or denial.
45) +/-: Use this button to add additional lines if you have more than one state certification or license.

Section 8 - Certification of Information Provided in Application
46) Applicant Signature: Please provide your electronic signature.
47) Print Name: Please print your full name.

Section 9 - Supporting Documents:
48) Please attach any supporting documentation here by clicking Choose File. Please note that all attached files must be in ZIP file format.

Once you have reviewed your application for accuracy and completion, use SUBMIT to submit your application. Use RESET to instead reset your application and begin again.