Free 36071.PDF - Indiana

State Form 36071 (R3 / 7-99)

Application for Approval of Real Estate Salesperson / Broker's Course
Please check which course you are applying for:

Salesperson

Broker

NOTE: Prior to completing this application, thoroughly review Rules 876 IAC 2-1-1 through 876 IAC 2-17-3; pertaining to requirements for approved courses of study.

Name of school

Street Address

City, state, ZIP code

Name of Director

Business telephone number

APPLICATION FOR APPROVAL OF REAL ESTATE SALESPERSON / BROKER'S COURSE
State Form 36071 (R3 / 7-99)

This state agency is requesting disclosure of personal information that is necessary to accomplish the statutory purpose of this state agency under IC 24-34-1-12. Disclosure of this information is voluntary. Failure to provide any information may prevent this form from being processed. Upon complet ion, this form will be treated as a public record. Date of application (month, day, year)

RETURN TO: Indiana Real Estate Commission 302 W. Washington St., Rm. E034 Indianapolis, IN 46204 NAME AND ADDRESS OF SCHOOL
Name of school Telephone number

(
Street address City, state, ZIP code

)

NAME AND ADDRESSES OF DIRECTORS AND OFFICERS

If incorporated, list names and residence addresses of all directors and officers.
Name Title

Street address (residence)

City, state, ZIP code

Name

Title

Street address (residence)

City, state, ZIP code

Name

Title

Street address (residence)

City, state, ZIP code

Name

Title

Street address (residence)

City, state, ZIP code

Attach:

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a copy of the Certificate of Incorporation; a Certificate of good standing of the corporation issued by the Secretary of the State of Indiana. PROOF OF SURETY BOND

Submit proof of Surety Bonding in the amount of $10,000. SUBMIT BOND REPORTING FORM. Submit copy of Accreditation Certificate. NAME AND ADDRESS OF COURSE DIRECTOR
Name Telephone number

(
Street address (residence) City, state, ZIP code

)

Attach:
Name

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Detailed resume. Review 876 IAC 2-2-4(c) School Director Qualifications. NAME AND ADDRESS OF PRINCIPAL INSTRUCTOR
Telephone number

(
Street address (residence) City, state, ZIP code

)

Attach:

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Detailed resume; Instructor Approval Application for each instructor. NAME AND ADDRESS OF ADDITIONAL INSTRUCTORS

If additional space is needed for other instructors, list on a separate sheet and attach to this form.
Name Telephone number

(
Street address (residence) City, state, ZIP code

)

Name

Telephone number

(
Street address (residence) City, state, ZIP code

)

Attach:

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Detailed resume for each additional instructor.

MINIMUM QUALIFICATIONS
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List your minimum qualifications required for instructors (training, experience, certification, etc.) Review 876 IAC 2-3-3 Instructor Qualifications. (Attach evidence of compliance)

FACILITIES
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Submit site approval form for each location. Yes No If answer is No, give name and address of owner.
Telephone number

Classrooms are owned by applying school.

Name of owner

(
Street address City, state, ZIP code

)

Physical facilities comply with all City, County and State fire, safety and sanitation codes and requirements.

Yes

No

If answer is No, give full particulars.

CLASSROOM DIMENSIONS

ROOM 1

ROOM 2

ROOM 3

ROOM 4

ROOM 5

Length Width Height
GRADING POLICIES Attach:
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Proposed school grading policy and rules of operation; Sample of proposed certificate to be issued to passing students. LENGTH OF COURSE
Clock hours per calendar week

Total length of course in clock hours

Clock hours per daily session

Total amount of weeks the course will last

Attach:

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Complete teaching syllabus; Keyed copies of all written examinations.

TEACHING SYLLABUS PROVIDED BY THE COMMISSION MUST BE USED IN EACH APPROVED COURSE.
COST OF COURSE Fee must include the cost of textbooks, supplemental texts and required materials. TEXT BOOKS

Cost of the course to the student $ _________________________ Attach:
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Detailed proposed refund policy and schedule of fees to the student.
Author Publisher

Title of primary textbook

Title of primary textbook

Author

Publisher

Title of primary textbook

Author

Publisher

Title of primary textbook

Author

Publisher

OTHER SOURCES OF INSTRUCTION MATERIAL
List other sources of instruction material (video tapes, cassette tapes, etc.)

I (we) the undersigned, submit this application in conformance with Section 12, Article 34 of the Indiana Code and the Rules and Regulations of the Indiana Real Estate Commission pertaining thereto for permission and authority to provide the heretofore described courses of instruction at the location specified. I (we) understand that any violation of the License Law or Rules and Regulations on my (our) part will subject me (us) to loss of approval. I (we) further certify that to the best of my (our) knowledge, the information given in this application is true and correct.
Signature of Director Signature of principal instructor

STATE OF INDIANA SS: COUNTY OF _________________________________

Subscribed and sworn to before me this __________ day of _______________________________________, ________.
Signature of Notary County of residence

Typed or printed name of Notary

Date Commission expires

SUMMARY OF DOCUMENTS TO BE ATTACHED BEFORE RETURNING THIS COMPLETED FORM

FOR OFFICE USE ONLY

Approval granted by Indiana Real Estate Commission.
Signature of approving authority

Date of approval (mo., day, yr.)

1. A copy of the certificate of incorporation. (if applicable) 2. A certificate of good standing of the Corporation issued by the Secretary of the State of Indiana. (if applicable) 3. Proof of Surety Bonding in the amouny of $10,000. (See Section "Proof of Surety Bond" on page 2) 4. Copy of Accreditation certificate. (if applicable) 5. Resume of course Director. 6. Resume of principal instructor 7. Resume of additional instructors 8. List of additional instructors and their resumes. (if applicable) 9. Proposed school grading policy and rules of operation. 10. Sample of proposed certificate to be issued to passing students. 11. Complete teaching syllabus. (if additional syllabus will be used) 12. Keyed copies of all written examinations. 13. Detailed proposed refund policy and schedule of fees to students. RETURN TO: Indiana Real Estate Commission 302 West Washington Street, Room E034 Indianapolis, IN 46204

Title

Remarks