Free 50669.pdf - Indiana

APPLICATION FOR ACCEPTANCE OF REAL ESTATE COLLEGE COURSE CREDITS
State Form 50669 (10-01)

Indiana Professional Licensing Agency 302 West Washington Street, Room E034 Indianapolis, Indiana 46204-2700 Telephone: (317) 232-2980 Fax: (317) 232-2312 Fax: (317) 233-5559

Name of applicant

Address (number and street, city, state, ZIP code)

I am applying for acceptance of college course credits as provided for in the INDIANA REAL ESTATE LICENSING ACT IC 25-34.1-3-3.1(a)(2). As evidence of complying with this section, I am submitting an original transcript from an accredited college or university showing that I have successfully completed courses totaling eight (8) semester credit hours in the following real estate related subjects:
SCHOOL COURSE CREDITS GRADE DATE

Date (month, day, year)

Signature of applicant

FOR OFFICE USE ONLY

APPROVED TABLED DENIED REASON REASON