Distance Education Instructor Application - South Carolina Real Estate Commission (Page 2 of 2) in pdf

Distance Education Instructor Application - South Carolina Real Estate Commission Page 2

V. LICENSING INFORMATION

TYPE OF LICENSE: _____________________________

DATE FIRST ISSUED: ____________________________

TYPE OF LICENSE: _____________________________

DATE FIRST ISSUED: ____________________________

VI. BACKGROUND/QUALIFICATIONS

(Your application will not be considered for approval unless this section is filled out completely.)

1. I HAVE HAD THE FOLLOWING EDUCATION RELATED TO TEACHING THESE COURSES: ____________________

___________________________________________________________________________________________________

2. I HAVE HAD THE FOLLOWING WORK EXPERIENCE RELATED TO THE COURSE(S) DURING THE LAST 5 YEARS:

Description of Experience

Affiliation

Year

(e.g. 2003-2007)

3. TEACHING EXPERIENCE DURING THE LAST FIVE YEARS:

Course(s) Taught

Taught for

Number of

Year Taught

Hours Per

(e.g. 2003-2007)

Year

4. I HAVE THE FOLLOWING CURRENT TEACHING CERTIFICATE(S):

VII. ACKNOWLEDGEMENT

I hereby apply for approval as an instructor, and I attest to having qualities of honesty, integrity, and trustworthiness. I have

not had any real estate license or instructor approval revoked or suspended, nor have I received a reprimand or a fine from

any regulating entity of any state. I have not been convicted of, nor entered a plea of nolo contendere to, any criminal

offense involving moral turpitude. I have not had any civil judgment entered against me based on fraud, misrepresentation,

or deceit. (If you answer yes to any of the previous statements, please attach documentation giving complete details.)

I have read and agree to comply with the South Carolina Real Estate License Law and Regulations and the Guidelines of

LLR - Real Estate Commission.

Personal information provided in this application may be subject to public scrutiny or release under the South Carolina

Freedom of Information Act or other provisions of Federal and State law.

I have attained the authority from the provider to instruct the course(s) which I am applying to teach on this

application.

Signed ________________________________________

Date _________________________________

VIII. ENCLOSURES

I HAVE ENCLOSED:

Application fee of $100 (if applicable)

Resume

Proof of degree in education (if applicable)

Teaching certificates (if applicable)

Copy of CDEI credential

Distance Education Instructor Application - South Carolina Real Estate Commission Page 2

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