Form 45666 - Application For Approval Of Real Estate Appraiser School Or Course
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1
2
3Indiana Professional Licensing Agency
APPLICATION FOR APPROVAL OF
Real Estate Appraiser Licensure and Certification Board
REAL ESTATE APPRAISER SCHOOL OR COURSE
302 West Washington Street, Room E034
Sta te Form 4 5666 (R2 / 2-03 )
Indianapolis, Indiana 46204-2700
Ap proved by State Board of A ccoun ts, 200 3
(317) 232-2980
FEE: $500.00
Da te of a pplication
NAME AND ADDRESS OF SCHOOL OR COURSE PROVIDER
Na me of school or course provider
Business teleph one
Addre ss (number and stre et, city, state, ZIP co de)
NAMES AND ADDRESSES OF DIRECTORS AND OFFICERS
Na me
Title
Addre ss - re side nce (n umber and stree t, city, state , ZIP cod e)
Name
Title
A ddress - residen ce (nu mbe r a nd street, city, state, ZIP code)
Name
Title
A ddress - residen ce (nu mbe r a nd street, city, state, ZIP code)
Name
Title
Add ress - residence (number and street, ci ty, state, ZIP code)
Attach: a copy of the Certificate of Incorporation;
a Certificate of Good Standing of the Corporation issued by the Secretary of State of Indiana.
PROOF OF SURETY BOND
ACCREDITATION CERTIFICATE
Attach: proof of surety bond in the amount of $10,000.
Attach: copy of accreditation certificate, if any.
LENGTH OF COURSE
Total length of the co urse in classroom h ours
Cla ssroo m hour s per daily se ssion
Total amoun t of course weeks
Cla ssroo m hour s per calend ar wee k
WRITTEN EXAMINATION
TEACHING SYLLABUS
Written exa min atio n r equire d u pon co urse completion ?
Attach: detailed teaching syllabus.
Yes
No
COURSE COMPLETION CERTIFICATE
Attach: certificate to be issued to students successfully completing course.
TEXT BOOKS
Title of primary textb ook
Publisher
Author
P ublisher
Title of add ition al textbook
A uth or
Title of ad ditional te xtbook
Author
Pub lish er
Title of additiona l textbo ok
Author
Publisher
OTHER SOURCES OF INSTRUCTION MATERIAL
List sources ( wo rkbo oks, vide o, cassette tape s, e tc.)
Page 1 of 3 pages
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