Form Dos-1503-F-A - Real Estate Qualifying Course Approval Application
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1
2
3New York State
Department of State
Division of Licensing Services
Bureau of Educational Standards
P.O. Box 22001
Albany, NY 12201-2001
(518) 486-3803
Real Estate Qualifying Course Approval Application
PLEASE READ CAREFULLY, AS INCOMPLETE APPLICATIONS WILL BE RETURNED.
» All applications must be submitted 60 DAYS BEFORE the proposed course is to be conducted.
» The non-refundable fee of $300 must accompany this original, signed application (photocopies will not be accepted). Fees may be paid by check or money
order (made payable to the Department of State) or by MasterCard or Visa, using a credit card authorization form. Do not send cash.
» A non-refundable fee of $150 must be submitted for each additional location.
» A fee of $20 will be charged for any check returned by the bank for insufficient funds.
» Annual registration period runs from September 1st to August 31st.
» Attach to application: the final examination(s) with answer key, reference page for each question and where the question falls in the curriculum. If
offering the brokers course, provide a two hour detailed outline with time sequence for the Local Concerns section of the broker course. Distance
learning courses require additional information as indicated in section 176.24.
1. PLEASE INDICATE THE TYPE OF COURSE
SALESPERSON
BROKER
CLASSROOM
DISTANCE LEARNING (Internet/Computer Based)
BOTH
2.
EDUCATIONAL ORGANIZATION DATA
SCHOOL NAME
ADDRESS (NUMBER AND STREET; ROOM/SUITE DESIGNATION)
CITY
STATE
ZIP+4
COUNTY
E-MAIL ADDRESS (IF ANY)
COORDINATOR’S NAME (person authorized to submit application on behalf of entity and responsible for administering Department of State regulations)
TELEPHONE
(
)
DOES THIS INDIVIDUAL HOLD A NEW YORK STATE REAL ESTATE LICENSE?
YES
NO
HOME ADDRESS (NUMBER AND STREET)
TELEPHONE
(
)
CITY
STATE
ZIP+4
3.
CLASSROOM COURSES ONLY
PRIMARY COURSE LOCATION
LOCATION ADDRESS (PLACE, NUMBER AND STREET; ROOM/FLOOR/SUITE DESIGNATION)
CITY
STATE
ZIP+4
COUNTY
4.
CLASSROOM COURSES ONLY
SECONDARY LOCATIONS (Each location requires an additional fee of $150)
LOCATION ADDRESS (PLACE, NUMBER AND STREET; ROOM/FLOOR/SUITE DESIGNATION)
CITY
STATE
ZIP+4
COUNTY
LOCATION ADDRESS (PLACE, NUMBER AND STREET; ROOM/FLOOR/SUITE DESIGNATION)
CITY
STATE
ZIP+4
COUNTY
LOCATION ADDRESS (PLACE, NUMBER AND STREET; ROOM/FLOOR/SUITE DESIGNATION)
CITY
STATE
ZIP+4
COUNTY
DOS-1503-f-a (Rev. 10/15)
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