06-2024

Mississippi Board of Licensure for

Professional Engineers & Surveyors
455 North Lamar Street, Suite 208,
Jackson, MS 39202
(601)359-6160

Manohar Vudumula

Chavidi street, dommaranandyala,

Mylavaram mandal, -516431,Andhra Pradesh, India

(Name and Address of PE Supervisor) (Name and Address of Applicant)

I have filed my application with the Mississippi Board of Licensure for Professional Engineers and Surveyors for licensure to practice
professional engineering in the State of Mississippi. I have listed your name as my Engineering Supervisor for the engagement period shown.
As a part of my application, I have submitted to the Board Office a signed, sworn and notarized certification of release statement authorizing
"any individual, company or institution with whom I have been associated to furnish the Mississippi Board of Licensure for Professional
Engineers and Surveyors with any information concerning my qualifications for professional licensure in Mississippi which they have on
record or otherwise, and do hereby release the individual, company or institution and all individuals connected therewith from all liability for
any damage whatsoever incurred by me as a result of their furnishing such information."

I will appreciate your sending the information requested on the reverse side directly to the Board in the stamped addressed envelope
which I have provided.
Digitally signed by Manohar Vudumula

Manohar Vudumula DN: cn=Manohar Vudumula, o, ou, [email protected],

c=US
Date: 2024.10.02 05:59:48 -07'00'

(Signature of the Applicant)

Board Statement to PE Supervisor:

This Board is required by law to ascertain that the applicant has met the experience requirement sections of the Licensure Law:
therefore, we need this experience verification form completed, signed, sealed, and returned by you. We cannot consider an applicant for
licensure or admit a candidate for examination until replies are received from PE supervisors. A prompt reply will expedite our handling of
the applicant's request for licensure.

QUALIFYING EXPERI ENCE: Experience must follow graduation, be progressive and of an increasing standard of quality and
responsibility. Experience must be gained by working under the supervision of a licensed Professional Engineer. If the experience was not
obtained under the direct supervision of a licensed Professional Engineer, then the indirect supervision should be explained with clarification
of the degree of supervision received. Military experience, to be creditable, must have been spent in engineering and of a character equivalent
to that required in the civilian sector in like work. For sales experience to be creditable, it must be demonstrated conclusively that engineering
principles and engineering knowledge were employed. The mere selection of data or equipment from a company catalogue or a similar
publication will not be considered engineering experience. Industrial experience should be directed toward the identification and solution
of practical problems in the applicant's area of engineering specialization. This experience should include engineering analysis of existing
physical systems and the design of new physical systems. Experience in construction supervision must include use of engineering skills in
assuring compliance with specifications and design. Design experience should include exposure to the formation of design problem
statements and specifications, consideration of alternative solutions, feasibility considerations and detailed systems descriptions.

This completed experience verification form is to be mailed directly to the Board Office in Jackson in the enclosed stamped
addressed envelope. PLEASE SEAL THE ENVELOPE, SIGNING YOUR NAME ACROSS THE SEALED FLAP. Your assistance will be
of value to the profession and your comments, except for the amount of verified experience, will remain confidential within thisBoard.

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EXPERI ENCE VERI FI CATI ON
(To be completed and returned directly to the Board Office)

TO BE COMPLETED BY APPLI CANT:

Applicant's Name: Manohar vudumula

Name of PE Supervisor:

Engineering experience to be verified for Engagement Number where employed as

a with the firm of .

(title of position)
Dates of PE supervision from to Total Months:

TO BE COMPLETED BY PE SUPERVI SOR:

1. Do you concur with the above applicant's: title and time? Yes No

2. My contacts with the applicant were during the period of time from to

3. Did you have review and approval authority over the applicant's engineering work? Please explain your

relationship with the applicant:

(continue on attached sheet if needed)

4. Please describe the applicant’ s duties & responsibilities in obtaining this experience (continue on attached sheet if needed):

5. Based on the Board's definitions of qualifying experience (refer to Page 1), please rank the applicant's experience:
The work performed by the applicant met the definition.
Approximately % of the applicant's work met the definition.
I do not have sufficient knowledge to answer.

6. Based on the Board's definitions of qualifying experience, X I do; I do not recommend the applicant for
licensure as a Professional Engineer.

7. Comments on applicant's qualifications to become a licensed Professional Engineer and to assume the responsibilities
connected therewith:

8. I certify that the above statements are correct to the best of my knowledge, not made for the purpose of aiding an unqualified
applicant to become licensed but with full realization of the responsibility toward the public where the safeguarding of life,
health and property is concerned or involved.

Signature
Please Affix
PE Seal here
Today’ s Date, State(s) of Licensure, & PE #(s)