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Real Estate Instructor Application Form - Nevada Department Of Business And Industry Real Estate Division

STATE OF NEVADA

DEPARTMENT OF BUSINESS AND INDUSTRY

REAL ESTATE DIVISION

REAL ESTATE INSTRUCTOR APPLICATION

PRE-LICENSING

POSTLICENSING

CONTINUING EDUCATION

1. Name of Applicant:

Mailing Address:

City, State, Zip:

Business Phone:

Fax Number:

Applicants E-Mail Address:

2. Name and address of school / organization or sponsor for which the applicant will instruct:

3. Title of course the applicant will instruct:

Course Number:______________________

Course Designation/Module

:__________________

(as applicable)

4. PROOF OF QUALIFICATION MUST BE ATTACHED to include:



Detailed resume defining dates (from-to) of schooling and experience. Describe experience in the field in which

applicant is applying to instruct so that resume clearly indicates how applicant is qualified to teach subject

matter of course per

NAC

645.426;



Copies of applicable documents (licenses, certificates, etc).

QUESTIONS 5, 6 AND 7 MUST BE ANSWERED BY APPLICANT:

5. Have you ever been refused approval of a license or certificate by any Federal, State, County or City agency?

Yes

If yes, attach an explanation.

6. Has any license or certificate held by you been suspended, revoked or subject to discipline?

Yes

If yes, attach an explanation.

7. Have you ever been subject to disciplinary action by any Federal, State, County or City agency?

Yes

If yes, attach an explanation.

INCOMPLETE SUBMISSION WILL RESULT IN DELAY OF APPLICATION

I declare under penalty of perjury under laws of the State of Nevada that the information provided above and on

the attached documents consisting of

pages is true and correct.

Executed on:

, 20

(Date)

(Signature of Applicant)

(Printed Name of Applicant)

Revision 12/17/2015

Page 1 of 2

635

2501 East Sahara Avenue, Suite 101, Las Vegas, NV 89104-4137 * (702) 486-4033 *

email: realest@red.nv.gov

Real Estate Instructor Application Form - Nevada Department Of Business And Industry Real Estate Division

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