Free 49490.PDF - Indiana

APPLICATION FOR REAL ESTATE CONTINUING EDUCATION INSTRUCTOR
State Form 49490 (9-99)

INDIANA PROFESSIONAL LICENSING AGENCY 302 W. WASHINGTON STREET, ROOM E034 INDIANAPOLIS, IN 46204 (317) 232-2980

Name of instructor

Address (number and street, city, state, ZIP code)

Name of continuing education sponsor

QUALIFICATIONS Instructors must possess at least one (1) of the following minimum qualifications. Please indicate all that apply. 1) An instructor of real estate courses who is or has been engaged in the practice of teaching at an accredited institution of higher education.
Name of institution

Dates of experience

2) An instructor for an Indiana approved real estate prelicensing course.
Name of school

3) Possession of a bachelor's degree from a college or university in a related field to that in which the person is to teach or a comparable degree from a school of a foreign country. (Attach transcript.)
List degree(s):

4) Five (5) years full-time experience in a profession, trade or technical occupation in the real estate field.
List occupation and dates of employment:

5) A combination of a total of five (5) years of: (A) Full-time experience relevant to the real estate field; and (B) a college level education. The combination may include no more than three (3) years of education.
List occupation and dates of employment:

List degree(s): (Attach transcript.)

6) Member of the State Bar of Indiana who is engaged in the field of real estate related law. (Attach copy of license.)
Outline in detail all teaching experience:

(Continued on the reverse side)

Outline in detail the qualifications which demonstrate your expertise in the real estate topics you will be teaching.

List memberships in any real estate related organization and any real estate teaching designations earned.

Have you attended an instructor class, seminar, or workshop in the last five years? If Yes, indicate approximate date, type of course, and sponsor/provider:

Yes

No

Are you currently licensed as a real estate salesperson or broker?

Yes

No

If Yes, indicate the state you are licensed in, your license number, and length of time actively licensed: State License number Length of time actively licensed:

Have you ever had a real estate license or any other license to practice in another profession denied, restricted, suspended, or revoked? If Yes, explain on a separate sheet of paper.

Yes

No

Is there any disciplinary action pending against you by a real estate or other licensing agency? If Yes, explain on a separate sheet of paper.

Yes

No

I, the undersigned, file this application in conformance with 876 IAC 4. I certify that the information given in this application is true and correct to the best of my knowledge.
Signature of applicant Date (month, day, year)