Free Print File - Michigan

BCS/LRE-003 (01/09) and Michigan Department of Energy, Labor & Economic Growthmailed to Testing & Education Services. This form cannot be submitted electronically. If you need Bureau of Commercial Services Testing, Education & Program Services to clear the form for any reason, click the clear P.O. Box 30018, Lansing, MI 48909 button. Phone: 517-241-9295 Fax: 517-241-7539 www.michigan.gov/bcstesting

This document can be completed on-line, printed

OFFICE USE ONLY
Date Approved: Approval Year:

PRELICENSURE INSTRUCTOR APPROVAL FORM REAL ESTATE SALESPERSON, BROKER PREPARATION & BROKER SPECIALTY COURSES
AUTHORITY: P.A. 299 of 1980, as amended COMPLETION: Mandatory PENALTY: Failure to complete may result in denial of your application

School/Sponsor Information (Please Type or Print)
Name of School/Sponsor School Approval Number Telephone Number

School/Sponsor Coordinators Name

School/Sponsor Address (Number & Street)

City

State

Zip Code

Applicant Information

(Please Type or Print)

Name of Applicant (First Name, MI, Last Name)

Applicant's Address (Number & Street)

City

State

Zip Code

Telephone Number

Cell Phone Number

Fax Number

E-Mail Address

Website

If you are an already approved instructor list the sponsor name and sponsor number for whom you are approved through.
Sponsor Name Courses To Be Taught Sponsor Number

If you are an new instructor provide the following information and check the appropriate boxes: Rule 101(1)(m) defines "instructor as an individual who possesses at least one of the following minimum requirements:
An instructor of real estate courses who is or has been engaged in the practice of teaching at an accredited institution of higher learning. Detail Qualifications:

A person properly licensed or certified by the department or other government agency who is engaged in the real estate aspects of appraising, financing, marketing, brokerage management, real property management, real estate counseling, real property law, or other related subjects. Detail Qualifications:

A person who possesses alternative qualifications approved by the department, and is qualified by experience, education, or both to supervise and instruct a course of study. Detail Qualification:

AND
I have attached a copy of my resume.

Signature of Instructor Signature of School Coordinator

Date Date

DELEG is an equal opportuinty employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.