Free Print File - Michigan

BCS/LRE-621 (09/05) Michigan Department of Labor & Economic Growth Bureau of Commercial Services Licensing Division TES - REAL ESTATE P.O. Box 30018, Lansing, MI 48909 517-241-9231 Fax: 517-241-7539 www.michigan.gov/realestate

This document can be completed on-line, printed and mailed to the Licensing Division with attachments. This form cannot be submitted electronically. If you need to clear the form for any reason, click the clear button.

OFFICE USE ONLY
Date Approved:

Approval Year:

CONTINUING EDUCATION INSTRUCTOR APPROVAL FORM
AUTHORITY: P.A. 299 of 1980, as amended COMPLETION: Mandatory PENALTY: Failure to complete may result in denial of your application

You May Duplicate This Form
1. Name of Sponsor (Please type or print) 2. Sponsor Number 3. Course Year For Which Approval is Sought 4. Sponsor Telephone Number

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New Application: first time instructor applicants. AN UPDATED RESUME MUST BE SUBMITTED. Notification: for applicants who have been approved in a prior year or for another Michigan sponsor. NO RESUME IS REQUIRED. Sponsor can submit a list of approved instructors to the Department for approval. 5. Name of Applicant (Please type or print)

6. Applicant's Address

City

State

Zip Code

7. Rule 101(1)(m) defines "instructor" as an individual who possesses at least one of the following minimum requirements (check applicable box): 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 Qualifications:

8. DISTANCE EDUCATION ONLY Explain knowledge and understanding of the delivery

9. Courses to be taught

10. Signature of Instructor

11. Daytime Telephone Number

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Signature of Sponsor/Coordinator

Date

The Department of Labor & Economic Growth will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, disability or political beliefs. If you need assistance with reading, writing, hearing, etc., under the Americans with Disabilities Act, you may make your needs known to this agency.