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Indiana Board of Licensure for Professional Geologists
Application to take the National Association of State Boards of Geology (ASBOG) Exam
Exam Schedule Test Dates Set by ASBOG
Fall, 2021 October 1, 2021
Spring, 2022 March 18, 2022
Fee Remittal Deadline
August 10, 2021
January 25, 2022
Test Dates Set by ASBOG
Fall, 2022 October 7, 2022
Spring, 2023 March 17, 2023
Fee Remittal Deadline
August 16, 2022
January 26, 2023
The Fundamentals of Geology and Practice of Geology exams are administered twice a year. Applications and fees must be received by the fee remittal deadline. The fees are $200.00 for the Fundamentals of Geology exam and $250.00 for the Practice of Geology exam. Please complete this form and remit with your payment to: Licensing Coordinator, Indiana Geological and Water Survey, 1001 E. 10th St., Bloomington, IN 47405. Payment can be made via check, cashier's check, or money order payable to "Indiana University" and mailed with your application. To pay with a Visa, MasterCard, Discover or American Express, please include the information with your mailed application or submit your payment online at https://igws.indiana.edu/LPG/Renew.cfm and then email the form (without the credit card information) to [email protected]. Credit card information can also be given to an IGWS Representative by phone during business hours (do not leave credit card information in a voicemail) after emailing the form. Effective January 15, 2015, the Indiana Geological and Water Survey and LPG Program NO LONGER PROCESSES payments received by email, voicemail or fax.
Last 4 digits of SocialSecurity Number
Date of Exam
(REQUIRED)
I agree to take the ASBOG exam(s) on the date specified above. I have enclosed the exam fee(s). If I choose not to take the exam(s), I agree to notify the Administrator before the exam date. I understand that in canceling or rescheduling my exam(s) after the deadline date, I will not receive a refund and will be required to pay an additional $25 rescheduling fee for each exam as required by the Association of State Boards of Geology.
Signature Date
I authorize Indiana University – Indiana Geological and Water Survey to charge my credit card for the total amount due.
Expiration Date
If emailing or faxing the form to the IGWS, DO NOT include payment information
Signature ______________________________________________
Name (as it appears on card)
FOR OFFICE USE ONLY KFS DOC ID. # DATE PAYMENT # DATE AMOUNT RECEIPT # RECEIVED DATE
Amount Due Examination Fundamentals of Geology Practice of Geology
Total Due
Unit Cost $200.00 $250.00
Total
Applicant Name
Mailing Address
City, State, Zip
Phone Number
Degree(s)
E-mail Address
Account Number
Updated 02.15.2021
