INSTITUTE OF TAX CONSULTANTS
APPLICATION FOR CERTIFICATION EXAMINATION
Upon completion of the Application please press "submit" for each page, then print out the form, sign it before an
Notary and mail to ITC.  Submitting the Application online first will expedite the processing of your request.
Mailing address:  Atten: Registrar, 7500 - 212th SW, Suite 205, Edmonds WA 98026
NAME
SOCIAL SECURITY #
HOME ADDRESS:
STATE:
ZIP:
BUSINESS ADDRESS:
STATE:
ZIP:
CITY:
HOME PHONE:
BUSINESS PHONE:
GENDER:
BIRTHDAY:
Date Passed: .
If you answered one or two and three, Finish background data, then skip to page 2 and complete. Enclose $45 to
cover Application fees and 2 years Certification.  Be sure to send "Other Items Needed."
1
2
3
BACKGROUND DATA
Answers to questions 2 & 3 are optional ad are intended to provide the applicant notice that these acts may bar certification. 
If the applicant wishes the Board to review specific circumstances prior to expending money and effort on the examination,
narrative may be included on a separate page.  If questions 4 & 5 are answered affirmatively, please provide details on a
separate sheet  and attach to this application.
1. Are you presently a member in good standing of any Trade Association with a major emphasis of federal income tax?
If yes, give name of the Association
2. Have you ever been convicted of a felony, an essential element of which is dishonesty or fraud?
3. Have you ever had a professional license or permit, or an enrollment to practice before the Treasury Dept. suspended or revoked? 
4. Have you ever been expelled from a professional society?
5. Have you ever been known by another name?
If yes, what other name?
6. Have you ever sat for this exam before?
If yes, location and date of exam.
EDUCATION
State in chronological order the name and location of each college or university attended, etc.  If your college work is not
completed, an official transcript need not accompany this application, but must be filed immediately after graduation.  If you
have been a paid tax preparer for three years out of the last four years, no transcript is needed.
NAME & LOCATION OF INSTITUTION   DATES ATTENDED         DATE        MAJOR & DEGREE
    FROM - TO           GRADUATED      RECEIVED
WORK EXPERIENCE AS A PAID PREPARER
NAME AND LOCATION (most recent first)     DATES: FROM  -  TO
OTHER ITEMS NEEDED:
EA's & CPA's
CERTIFICATION FEE:  When you receive your pass notice you will receive a statement for the first two years of
certification.  The fees should be paid immediately so that your Certificate can be issued.
GO TO PAGE 2
Home Page
CITY
PRINT THIS PAGE (legal size) THEN
MF
I have passed the Enrolled Agents or Certified Public Accountants exam within the last year.
I have been an Enrolled Agent or Certified Public Account for more than one year.
As a EA or CPA I have 60 hours of CPE within the past two years.
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Letter of recommendation from a business associate outside of your firm, or from a client.
3x5 colored photo of upper body.
List of CPE hours for past two years (except 1st year EA's)
Copy of EA or CPA certificate, or card, or pass notification