State Form 46182 - Application For Approval Of Real Estate Continuing Education Course Sponsor - 2010

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APPLICATION FOR APPROVAL OF REAL ESTATE

INDIANA PROFESSIONAL LICENSING AGENCY

CONTINUING EDUCATION COURSE SPONSOR

402 West Washington Street, Room W072

Indianapolis, IN 46204

State Form 46182 (R3 / 8-10)

Telephone: (317) 234-3009

Fax: (317) 233-4236

Approved by State Board of Accounts, 2010

E-mail: pla9@pla.IN.gov

INSTRUCTIONS:

(1) Include a school director resume listing experience in detail, and a college transcript if applicable.

(2) Include descriptive course content outline for each course, including a cover sheet indicating the number of hours awarded. The outline must include

a timeline for each item to be discussed.

(3) Include instructor application for each instructor.

(4) Include an example of the certificate which will be issued to licensees who complete the course. Certificate requirements are listed in 876 IAC 4-1-2.

(5) Include fee of $50.00. All fees are non-refundable and non-transferable. To sponsor both salesperson and broker courses, include a fee of $100.00.

Date of application (month, day, year)

Type of sponsorship (check only one)

Salesperson

Broker

SPONSOR INFORMATION

Name of course sponsor

Business telephone number

(

)

Address of course sponsor (number and street, city, state and ZIP code)

E-mail address (required)

SCHOOL DIRECTOR INFORMATION