Distance Education Instructor Application - South Carolina Real Estate Commission printable pdf download

Distance Education Instructor Application - South Carolina Real Estate Commission

SOUTH CAROLINA REAL ESTATE COMMISSION

DISTANCE CONTINUING EDUCATION

INSTRUCTOR APPLICATION

PLEASE RETURN TO: SC LLR - REAL ESTATE COMMISSION, P.O. BOX 11847; COLUMBIA, SOUTH CAROLINA 29211-1847

I. PERSONAL INFORMATION

NAME: _____________________________________________________LICENSE #____________________________

MAILING ADDRESS: _________________________________________________________________________________

CITY, STATE, ZIP CODE: _____________________________________________________________________________

WORK PHONE NUMBER: __________________________

FAX NUMBER: __________________________________

HOME PHONE NUMBER: ___________________________

E-MAIL: _________________________________________

II. APPLYING TO TEACH

Course Number

Course Title

III. CERTIFICATION TO TEACH COURSE

(Initials are required after the following statement)

I have taken the following action to prepare myself to teach in this medium:

I have obtained the Certified Distance Education Instructor (CDEI) designation that permits me to

instruct Instructional Distance Education Certification Center (IDECC) certified courses.

________________

I have personally completed the course using the designated distance education delivery

method approved for the course(s) I am applying to instruct.

________________

IV. AVAILABILITY TO STUDENTS

Explain how instructor will be available to support and interact with students. (Give Specific Details): _________________

___________________________________________________________________________________________________

REC Form

Rev 3/09

Previous editions of this form are obsolete.

Please complete the next page of this form.

Distance Education Instructor Application - South Carolina Real Estate Commission