Interior Design Examining Board
200 E. Grand, Suite 350, Des Moines, IA 50309
(515) 725-9022 | InteriorDesignBoard@iowa.gov | www.plb.iowa.gov
Interior Design Registration Work Verification Form
Section One to be completed by the Applicant
Applicant Name: First Middle
Description of Work:
Description of work must accurately, briefly, and concisely describe the character of the work, the
degree of responsibility, and the location of work.
Date of Employment (mm/dd/yy) From: To:
Number of hours worked per week:
Section Two to be Completed by the Supervisor
Please complete and e-mail the form to InteriorDesignBoard@iowa.gov.
City: State: Zip:
Are you a registered interior designer? Yes No
Your evaluation of the applicant’s interior design ability is:
Do you recommend this applicant for registration? Yes No
Is all the information the applicant provided in Section 1 correct? Yes No
If no, please explain:
I hereby affirm/attest that all information provided above and in Section 1 is correct.