State Form 45016 - Application For Real Estate Appraiser Certification

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APPLICATION FOR REAL ESTATE
REAL ESTATE APPRAISER LICENSURE & CERTIFICATION BOARD
PROFESSIONAL LICENSING AGENCY
APPRAISER CERTIFICATION
402 West Washington Street, Room W072
State Form 45016 (R10 / 9-10)
Indianapolis, Indiana 46204
Telephone : (317) 234-3009
Approved by State Board of Accounts, 2010
E-mail: pla9@pla.IN.gov
INSTRUCTIONS:
Please completely fill in your PDF viewer or type.
* Your Social Security number is being requested by this state agency in accordance with Indiana Code. Disclosure is mandatory, and this record cannot be processed without it.
FOR OFFICE USE ONLY
Application fee
Date fee paid (month, day, year)
Receipt number
Certificate number issued
Date license issued (month, day, year)
License obtained by
DO NOT WRITE ABOVE THIS LINE
APPLICANT INFORMATION
APPLICANT INFORMATION
TYPE OF CERTIFICATION
Certified residential appraiser
Certified general appraiser
What type of license or certification are you applying for? (Please check only one)
APPLICANT INFORMATION
APPLICANT INFORMATION
APPLICANT INFORMATION
Social Security number *
Name of applicant (first, middle, last, maiden or previous)
Current address (number and street or rural route, city, state and ZIP code)
Permanent address (if different from above, number and street or rural route, city, state and ZIP code)
Work telephone number
Other telephone number (cell or home)
E-mail address (required)
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)
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)
Date of birth (month, day, year)
Place of birth (city, state)
EDUCATIONAL REQUIREMENTS
Certified Residential: You must have 200 hours of pre-licensing education. In addition you must also have an Associate Degree or
higher. In lieu of the required degree, you must have a minimum of twenty-one (21) semester hours covering the following subject matter
courses: English Composition; Principles of Economics (Micro or Macro); Finance; Algebra; Geometry or higher mathematics; Statistics;
Introduction to Computers (Word Processing, Spreadsheets); and Business or Real Estate Law.
Certified General: You must have 300 hours of pre-licensing education requirements. In addition, you must have a Bachelors Degree
or higher. In lieu of the required degree, you must have a minimum of thirty (30) semester credit hours covering the following subject
matter courses: English Composition; Micro Economics; Macro Economics; Finance; Algebra, Geometry or higher mathematics; Statistics;
Introduction to Computers (Word Processing, Spreadsheets); Business or Real Estate Law; and two (2) elective courses in Accounting,
Geography, Ag-economics, Business Management, or Real Estate.
COLLEGE REQUIREMENTS
Certified Residential: (please check one of the following and submit an official unopened transcript with your application)
I have an Associates degree or higher.
I have twenty-one semester hours in the necessary fields.
Certified General: (please check one of the following and submit an official unopened transcript with your application)
I have a Bachelors degree or higher.
I have thirty semester hours in the necessary fields.
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