State Form 46355 - Application For Real Estate Trainee Appraiser Examination/licensure - 2003

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APPLICATION FOR REAL ESTATE
Real Estate Appraiser Licensure and Certification Board
Indiana Professional Licensing Agency
TRAINEE APPRAISER EXAMINATION / LICENSURE
302 West Washington Street, Room E034
State Form 46355 (R3 / 4-03)
Indianapolis, Indiana 46204-2700
Approved by State Board of Accounts, 2003
T elephone: (317) 232-2980
INSTRUCTIONS: Please type or print this application in ink.
Applicants must read Real Estate Appraiser Licensure and Certification statutes and rules before completing and filing the application.
Application fee: $100.00
Make check or money order payable to: Indiana Professional Licensing.
Application fee is nonrefundable and nontransferable.
1. Name of applicant (first, middle, last)
2. Residence address (number and street, city, state, ZIP code)
3. Mailing address (number and street, city, state, ZIP code)
*
This a
4. Social Security number *
gency is requesting the disclosure of your Social Security number in accordance
with IC 4-1-8-1. Disclosure is mandatory; this record cannon be processed without it.
.
Social Security numbers will be made available to the Indiana Department of Revenue
5. Residence telephone number
Business telephone number
6. Date of birth (month, day, year)
(
)
(
)
APPRAISAL EDUCATION REQUIREMENTS
List below all appraisal courses the applicant completed that consisted of at least fifteen (15) classroom hours and where the applicant successfully completed
an examination. (No correspondence courses will be considered.) A classroom hour consists of fifty (50) minutes. Credit for duplicate courses will not be
considered. T o obtain credit for courses prior to July 1, 1990, applicant must submit verification in the form of a certificate, transcript or letter issued by the
course provider showing course title, date of successful course completion, and number of classroom hours. T o obtain credit for courses after June 30, 1990,
applicant must submit verification in the form of a certificate of course completion which must include name of sponsoring organization, course title, identify
course content, dates of course, certify
minimum of fifteen (15) hours, hours completed, passing grade, and state name.
Education requirements: 90 hours
MONTH / YEAR COMPLETED
COURSE TITLE
COURSE PROVIDER / SCHOOL NAME
NUMBER OF HOURS
TOTAL HOURS
Attach separate sheet of paper if you need more room, using the above format. Staple to this application and mark addendum.
(Continued on reverse)

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