Form Re-620-124 - Real Estate Secondary Provider Course Content Approval Application - Washington Department Of Licensing

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Real Estate Secondary Provider
Course Content Approval Application
You can use this form to apply for approval or renew approval to be a secondary provider for a real estate course that has
been pre-approved for the original provider/course developer. Do not use this application for Real Estate Fundamentals,
Real Estate Brokerage Management, Real Estate Law, Advanced Real Estate Law, Business Management, Real Estate
Practices, Advanced Practices, Transition Course, or courses that include the prescribed core curriculum.
Send this competed form and any required attachments to:
Real Estate
Department of Licensing
PO Box 9021
Olympia, WA 98507
Select one:
Original approval
Renewal approval for course ID number________________________
Select delivery medium:
Live lecture
Distance education – delivery method__________________________
attach Real Estate Distance Education Delivery Method Application (BPD-600-002B) unless this course has been
certified by ARELLO for your school.
Original applications only must also include the following:
• Written authorization by the original education provider/course developer permitting use of the course content
• ARELLO certificate, if applicable.
Provider information
Name of provider
School ID number
Address (Street, PO Box, Suite number)
City
State
ZIP code
(Area code) Telephone number
(Area code) FAx number
email address
Contact person
(Area code) Telephone number (if different)
Course information
Course title
Original provider/course developer course ID number
Number of clock hours
Expiration date
Original provider/course developer
School ID number (if applicable)
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
_____________________________________
_________________________________________________________
Date and Place
School administrator’s signature
WAC 308-124H-825
Once filed, this application is a public record and is subject to public disclosure. RCW 42.56
We are committed to providing equal access to our services.
If you need accommodation, please call (360)664-6505 or TTY (360)664-0116.
RE-620-124 (R/2/11)W

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