Ce Elective Course Sponsor Application (Form Rec 7.06) - North Carolina Real Estate Commission Page 3
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310.
Criminal Offenses. Has any person listed in Items 1, 6, or 9 ever been convicted of any
criminal offense (felony or misdemeanor) or is there any criminal charge now pending
against such person? (This includes driving while impaired and other serious traffic
YES
NO
offenses. Exclude only minor traffic offenses.) ....................................................................................
[If “Yes,” attach a copy of the court judgment, release from parole or probation,
and a complete explanation from each affected person providing full details .]
11.
Professional License Disciplinary Action. Has any person/entity listed in Items 1, 6, or 9
ever been denied a real estate or other business or professional license or been disciplined
by an occupational licensing agency (license suspended, revoked, surrendered, reprimanded,
etc.) in NC or elsewhere: or are there currently any charges or complaints pending against
YES
NO
them in connection with any real estate or other professional license that they hold? ..........................
[If “Yes,” attach a copy of the licensing agency’s order and a complete explanation
from each affected person providing full details.]
12.
Out-of-State Sponsor. [An applicant with an out-of-state business address (or residence address if a sole proprietor with no sepa-
rate place of business) must submit a completed “Consent to Service of Process and Pleadings” form.]
13.
Signature and Certification of Applicant (Course Sponsor). [If the course sponsor applicant has not been previously approved by the
Commission or if previous approval has expired, this application must be signed by the owner (if a sole proprietorship), a managing partner
(if a partnership), or a major officer authorized to submit such application (for other types of business entities). If applicant is an accredited
community college, college/university or junior college, the application must be signed by the vice-president or dean responsible for the insti-
tution’s continuing education program (or by the institution’s president). If the applicant is a currently approved elective course sponsor, this
application may be signed by the applicant’s Continuing Education Coordinator or by the persons indicated above].
I hereby certify that all information submitted in connection with this application is true and accurate to the best of my knowledge
and belief. I understand that any omission or inaccuracy may be grounds for denial of approval of the course.
I further certify that the applicant and all persons in its employ will fully comply with the requirements of the North Carolina Real
Estate Commission regarding the conduct of continuing education courses.
I further certify that, except for obtaining approval of the North Carolina Real Estate Commission to conduct real estate continuing
education courses, the applicant has complied with all legal requirements to engage in business in North Carolina.
________________________________________________
_____________________________________________
Name (print)
Title
________________________________________________
______________________________________________
Signature
Date
Page 3 of 3
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