Nebraska Real Estate Examination Salesperson Retake Application Form

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NEBRASKA REAL ESTATE COMMISSION
Phone: 402-471-2004
PO Box 94667
Fax: 402-471-4492
Lincoln, NE 68509-4667
Website:
E-mail:
realestate.commission@nebraska.gov
FOR COMMISSION USE ONLY
RECEIPT #
NEBRASKA REAL ESTATE EXAMINATION
SALESPERSON RETAKE APPLICATION
FEES ARE NOT REFUNDABLE
RETAKE EXAMINATION FEE: $150.00
INSTRUCTIONS:
1.
Retake applications must be filed in the Real Estate Commission office.
2.
Send this application to the Real Estate Commission office with the appropriate examination fee.
3.
NOTE: If your original or updated application is more than one year old, a new original application,
including a photo and full application fee, will be needed.
4.
Mail this completed application form and appropriate fee to:
Nebraska Real Estate Commission
P.O. Box 94667
Lincoln, NE 68509
CREDIT CARD PAYMENT OPTION: REMINDER - FEES ARE NOT REFUNDABLE
(Please note: debit cards are not accepted)
_____Please charge my credit card for only this transaction.
_____VISA
_____MasterCard
_____Discover
Credit Card Number: ______________________________________ Card Expiration Date: Month ________ Year ________
Cardmember=s Signature: _________________________________________________________________________________
PLEASE PRINT LEGIBLY:
Please mark the portion of the exam you need to retake: State_______National________Both_______
You will only be allowed access to the portion of the examination indicated by our records and in compliance with the license
regulation. If our records do not agree with the portion you indicated, above, we will attempt to contact you so that you may
prepare appropriately. Please provide a telephone number and e-mail address where you can be reached.
Name__________________________________________________________________________________________________
Last
First
Middle
Social Security Number
Residence Address_____________________________________________________________________________________
Street Number - Mailing Address
City
__________________________
__
(
)
.
County
State
Zip
Telephone Number
Date of Birth_______________________________
E-mail Address _______________________________________________
I hereby make application to retake the Nebraska Real Estate Salesperson Examination. I have taken the examination at
a prior time and have been notified that I failed to receive a passing grade.
Submission of this Salesperson Retake Application verifies that all statements and information provided herein are true
and correct and may be used as necessary by the Nebraska Real Estate Commission if furtherance of assuring
compliance with the laws it regulates.
Applicant=s Signature _____________________________________________
Date____________________________
W:\USERS\FORMS\PDFFORMS\SALESRETAKE.DOC
Revised 6/15

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