<p> Applicant Fingerprinting Form</p><p>Name:______Last First Middle Address:______</p><p>City:______State:______Zip:______</p><p>Daytime Contact # ______Social Security #:______-_____-______</p><p>Date of Birth:_____/_____/_____ Birthplace:______Month Day Year State</p><p>Citizenship:______Height:______Weight:______</p><p>Original TCN (if this is a reprint) ______</p><p>CIRCLE CODES THAT APPLY </p><p>SEX HAIR COLOR EYE COLOR Male ...... M Female...... F Bald ...... BAL Black ...... BLK Black ...... BLK Blue ...... BLU RACE Brown ...... BRO Brown ...... BRO Asian or Pacific Islander . . A Gray/Part Gray . . . GRY Gray ...... GRY Black ...... B Red/Auburn ...... RED Green ...... GRN American Indian or Sandy ...... SDY Hazel ...... HAZ Alaskan ...... I White ...... WHI Maroon ...... MAR Unknown ...... U Multicolored . . . . . MUL White ...... W Pink ...... PNK</p><p>Go to www.L1Enrollment.com or call 1-877-472-6917 to schedule fingerprinting appointments. Use requesting agency information below to ensure correct processing and fees.</p><p>Please bring your Drivers License (or other State or Federal issued Photo ID) to your fingerprint appointment</p><p>Requesting Agency Information (This information must be provided by your REQUESTING AGENCY.)</p><p>Agency Name: Professional Licensing Agency Applicant Category: Real Estate Appraiser</p><p>A criminal history background check is required for a real estate appraiser license in Indiana pursuant to Indiana law. The information submitted with this application and the criminal history report itself are confidential. The criminal history report is used solely by the Indiana Professional Licensing Agency as a condition precedent for licensure. Neither the application nor the criminal history report is accessible through or by a public records request except as otherwise provided by law.” </p>