Form Dos-1503-F-A - Real Estate Qualifying Course Approval Application Page 3
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3Real Estate Qualifying Course Approval Application
Has any owner, partner, owner of 5% or more of the stock of the entity, or individual authorized to submit this application on behalf of the
8.
entity been convicted of any crime or offense, other than a minor traffic violation?
Yes*
No
If Yes*, submit a certified copy of each conviction.
Has any license or permit issued to, applied for by any owner, partner, holder of 5% or more of the stock of the entity, or individual
9.
authorized to submit this application on behalf of the entity, been denied, suspended or revoked by this state or elsewhere by any other
governmental or regulatory body?
Yes*
No
If Yes*, please provide details.
Course Instructors: All instructors of approved courses must be approved with the Department of State. Applications for real estate instructor
approval are available by request to the Division of Licensing Services, Bureau of Educational Standards. A one time
evaluation and filing fee of $25 is required for each instructor’s approval.
. COURSE CONTENT - ALL OF THE FOLLOWING MUST BE SUBMITTED:
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a detailed course outline for Local Concerns when applying for the broker course approval. (See Section 11 of broker curriculum.)
the final examination to be presented for the course, including the answer key, the reference source and reference page for each
question and subject matter category.
the passing grade for the examination
%.
a description of materials that will be distributed.
the books that will be utilized in the course and final examination.
list of names and signatures of individuals authorized to sign certificates (cannot be a real estate licensee or licensed/certified appraiser).
a fee of $300 for the salesperson and/or broker course and $150 for each additional location.
additional documentation required for distance learning courses (section 176.24).
I subscribe and affirm under the penalties of perjury that the statements made in this application (including statements made in any
accompanying papers) have been examined by me, and to the best of my knowledge and belief, are true and correct.
I understand that any misstatement made on this application for approval could result in an immediate revocation or withdrawal of the
recognition of the approval of the entity by the Department of State.
Coordinator Signature
X
Date
DOS-1503-f-a (Rev. 10/15)
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