Fillable CONTINUING EDUCATION COURSE APPLICATION (Utah DRE)

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CONTINUING EDUCATION COURSE APPLICATION (Utah DRE)

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Utah Division of Real Estate (DRE) aims to protect the public and promote responsible business practices through education, licensure, and regulation of real estate, mortgage, and appraisal professionals

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Rev. 12/18/2013
160 East 300 South, PO Box 146711, Salt Lake City, UT 84114-6711
Telephone (801) 530-6747 • Facsimile (801) 526-4387 • Internet: www.realestate.utah.gov
State of Utah
Department of Commerce
Division of Real Estate
CONTINUING EDUCATION COURSE APPLICATION
Please complete (type or neatly print) and submit this form, the items listed below, and non-refundable fee ($75)
to the Utah Division of Real Estate by fax, mail, or in person at the address below.
**APPLICATIONS MUST BE SUBMITTED NOT LESS THAN 30 DAYS PRIOR TO THE DATE OF THE FIRST CLASS**
Industry: ( ) Appraisal ( ) Real Estate ( ) Mortgage Credit Hours Requested: __________
Course Title: _________________________________________________________________________________________________
Course Description: ( ) Traditional Classroom ( ) Distance Education (online) Course Credit: ( ) Core ( ) Elective
**Course Date(s): _______________________________Continuing Education Provider ID #________________________________
Contact Person: ________________________________________________________________ Ph: __________________________
Company: _____________________________________________________________________ Fax: _________________________
Address: ____________________________________________________________________________________________________
Website: _______________________________________________ Email: ______________________________________________
( ) CE Instructor Application or copy of the Instructor Certification for each proposed course instructor.
Instructor License #:_________________________
( ) A copy of the written policy and procedure for ensuring student attendance during class time.
( ) For Distance Education approval, submit instructions for accessing and reviewing the course.
( ) A timed course outline that provides a subject matter description for each 15 minute interval, using the following format.
Provide learning objectives that indicate how the course will improve the licensee’s ability to protect and serve the public.
(If requesting core credit please be specific as to why this course should be approved as core credit):
Licensee will be able to: _______________________________________________________________________________________
____________________________________________________________________________________________________________
Licensee will be able to: _______________________________________________________________________________________
____________________________________________________________________________________________________________
Licensee will be able to: _______________________________________________________________________________________
____________________________________________________________________________________________________________
Licensee will be able to: _______________________________________________________________________________________
____________________________________________________________________________________________________________
I have read and understand the administrative rules governing continuing education. I agree to allow the course to be audited on an
unannounced basis by the Division. I also agree to not market for a specific company, professional service, or personal sales products.
Signature ___________________________________________________ Date ______________________________
( ) Check ( ) Visa ( ) MasterCard ( ) American Express
Make checks payable to: Utah Division of Real Estate
Card # ____________________________________ Expires __________
Signature _________________________________ CCV# ___________
OFFICE USE ONLY
Date Reviewed _______________ By _______
( ) Denied ( ) Approved
Certification _________________ Exp. ______
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CONTINUING EDUCATION COURSE APPLICATION (Utah DRE)

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Completed 22 January 2021

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