Free 43492.pdf - Indiana

FOR COMMISSION USE ONLY

APPLICATION FOR INSTRUCTOR APPROVAL
State Form 43492 (R / 5-93)

Date (month, day, year)

Approved Denied

Temporary Approval

This application and documentation are MANDATORY and must be submitted with ALL SCHOOL REQUESTS for instructor approval. Carefully complete the entire form and return to: INDIANA REAL ESTATE COMMISSION Indiana Government Center South 302 West Washington Street, Room E034 Indianapolis, Indiana 46204 Telephone: (317) 232-2980

Reason(s) for denial

By Commissioner:

THIS FORM MUST BE TYPED OR PRINTED
1. Name (last) (first) (middle) 2. Mail to be addressed as:

Mr.
3. Residence address (street or rural route)

Mrs.

Ms.

Miss

City

State

ZIP code

4. School requesting approval

5. School address (street)

City

State

ZIP code

6. School telephone number

Residence telephone number

7. Employer / Firm name

8. Employer address (street)

City

State

ZIP code

9. Date employment began (mo., day, yr.)

10. Title / position held

11. Citizenship

U.S.A. by birth A. Secondary School
Name and location

U.S.A. by naturalization

Non-citizen 12. EDUCATION
Year of graduation

Other

B. Colleges and Universities (please provide a copy of your diploma) Name and Location

Dates attended

Major

Degree(s)

Graduation

13. Experience in Real Estate industry

14. Teaching experience

Position / Title

15. PREVIOUS EMPLOYMENT FOR PAST TEN YEARS (if not listed in Real Estate or Teaching section) Dates of Employment Name / Address of Employer From To

Full or Part-time

16. REFERENCES

Please provide the names, addresses and telephone numbers of three persons associated with the Real Estate industry who can provide the Commission with information concerning you.
Name / Address of Reference Telephone Number

17. Awards or memberships related to the Real Estate industry

18. Have you ever been requested to appear in court or before a public official including the Indiana Real Estate Commission for misconduct in your professional work or have you ever been disciplined for ethical practices in the Real Estate industry? Yes No If Yes, elaborate on a separate sheet.

PLEASE NOTE: INSTRUCTORS ARE NOT REQUIRED TO HOLD A VALID BROKER'S LICENSE. HE/SHE IS ONLY REQUIRED TO PROVIDE PROOF THAT HE/SHE HAS PASSED THE EXAMINATION. 19. You must provide evidence of passing the Indiana Real Estate Broker's Examination (copy of license, pocket card or examination passing notice is acceptable). 20. You must provide evidence of passing the Instructor Assessment Program examination. (copy of IAP score card is acceptable) ITEMS 19 and 20 must accompany this application. THE FOLLOWING SECTION APPLIES ONLY TO APPLICANTS REQUESTING INITIAL INSTRUCTOR APPROVAL. PLEASE DO NOT COMPLETE THIS SECTION IF YOU ARE CURRENTLY AN APPROVED INSTRUCTOR.
Check basis upon which you are qualifying (attach applicable college transcripts or diploma)

876 IAC 2-3-3 Instructors' qualifications Authority: IC 25-34.1-2-5 Affected: IC 25-34.1-5 Sec. 3(a) Each instructor shall posses at least one (1) of the following minimum requirements: 1. A bachelor's degree with a major or minor in Real Estate from an accredited college or university. 2. A bachelor's degree from an accredited college or university and a minimum of two (2) years experience in Real Estate. 3. An Indiana Real Estate broker's license and has a minimum of five (5) years experience as a Real Estate broker in Real Estate practice as defined in 876 IAC 1-1-3(n) and (p). 4. A juris doctor or equivalent from an accredited law school and a minimum of two (2) years experience in the subject matter to be taught in the course. 5. Two (2) years experience as a qualified instructor or professor in the business, finance or economics department of an accredited college or university.
Signature of applicant Date signed (month, day, year)