North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1422 • Fax 919-733-4209 • Web www.nccpaboard.gov
Full Name (First/Middle/Last/Suffix)
Mailing Address (Street or PO Box)
City, State, Zip Code
Home Telephone Number Business Telephone Number
Birthdate (MM/DD/YYYY) Birthplace (City/State/Country) Social Security Number
If you have previously used another name, provide that name here:
(1) Prepare the applicant's section of the Authorization for Interstate Exchange of Examination and Licensure Information
and forward the form and a self-addressed stamped envelope to the appropriate board of accountancy (BOA) for
proper completion. Request that the form be returned directly to you. Before sending this form for completion by the
BOA, contact the BOA to determine if you need to meet additional requirements or pay any fees before such
information will be released.
(2) Have you filed an application for a North Carolina CPA certificate? Y N
(3) Have you filed an application to take the Uniform CPA Exam as a North Carolina candidate? Y N
(4) If you have not already done so, request that each college or university where you successfully completed accounting
courses submit official transcripts* of courses directly to you to include with your application.
(5) 21 NCAC 08F .0106 permits the transfer of Uniform CPA Exam grades only if they are earned in accordance with 21
NCAC 08F .0105.
(6) Application Fee: If you are applying for a North Carolina CPA certificate, there is no additional application fee. If you
are transferring grades only, the fee is $75.00. Please make your check payable to the NC State Board of CPA
Examiners or include a $75.00 credit card authorization.
Affidavit of Applicant
I understand that all of the information in this application and other documents to be filed with the Board in connection with
this application are a matter of public record and are available for public inspection. I declare under the penalties of perjury
that the information and statements made in this application are, to the best of my knowledge and belief, true, correct, and
Signature Date:
*E-Transcripts, such as those requested through the National Student Clearinghouse, are deemed unofficial if printed and
submitted with your application. You may request that the college or university send the transcript directly to Alice Grigsby
(aliceg@nccpaboard.gov) in the Board’s Licensing Section.
FOR BOARD USE: Amt. Paid Deposit No. Deposit Date