Fillable CONTINUING EDUCATION INSTRUCTOR APPLICATION (Utah DRE)

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CONTINUING EDUCATION INSTRUCTOR APPLICATION (Utah DRE)

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The CONTINUING EDUCATION INSTRUCTOR APPLICATION (Utah DRE) form is 2 pages long and contains:

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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. 12/17/2013
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 INSTRUCTOR APPLICATION
Please complete (type or neatly print) and submit this form, the items listed below, and non-refundable fee ($50)
to the Division by fax, mail, or in person.
**APPLICATIONS MUST BE SUBMITTED NOT LESS THAN 30 DAYS PRIOR TO THE DATE OF THE FIRST CLASS**
Name: ________________________________________________________ Industry: ( ) Mortgage ( ) Real Estate
Address: _____________________________________________________________________________________________________
Phone: ________________________________ SS#: ________________________________
(Social Security Verification Form Required)
Course Title: _________________________________________________________________________________________________
Course Sponsor: _________________________________________E-mail: _______________________________________________
Provide evidence demonstrating subject matter knowledge and ability to effectively teach:
( ) Any combination of at least two years of full time experience and/or college-level education related to the course subject. (Provide
resume and/or college transcripts)
( ) State teaching certificate, college courses in the field of education, professional teaching designation from a related industry
association, or letters of reference regarding your teaching ability.
Yes No
1. Are you at least 18 years of age?
2. Do you attest that you have a high school diploma or GED?
3. Have you EVER had a professional or occupational credential (license, registration, certification, or
similar authorization to work in a professional or occupational capacity) denied, revoked, or
suspended?
4. Have you EVER had a professional or occupational credential (license, registration, certification, or
similar authorization to work in a professional or occupational capacity) sanctioned? Sanctions include, but are
not limited to, having a credential restricted, limited, placed on probation, being required to pay a fine or
penalty, take education, or comply with any other condition?
5. Have you EVER been sanctioned or banned from engaging in any activity by Freddie Mac, Fannie
Mae, FHA (HUD), VA, or similar organization for any period of time or for any reason?
6. Have you EVER been ordered to cease and desist from any conduct related to a professional or
occupational credential (license, registration, certification, or similar authorization to work in a professional or
occupational capacity)?
7. Have you EVER allowed a professional or occupational credential (license, registration, certification,
or similar authorization to work in a professional or occupational capacity) to expire or lapse while you were
under investigation by a regulatory or licensing body, or while a regulatory action was pending against you?
8. Do you have knowledge of any complaint, investigation, or disciplinary action CURRENTLY
ongoing or pending against you by a regulatory or licensing body?
( ) 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. ______
Rev. 12/17/2013
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 INSTRUCTOR APPLICATION
Yes No
9. Have you EVER been convicted of, or pled guilty or nolo contendere to a felony, class A
misdemeanor, class B misdemeanor, or comparable criminal offense? A traffic offense can be prosecuted as a
felony, class A misdemeanor, class B misdemeanor, or comparable criminal offense. Where this is the case
disclosure is required.
10. Have you EVER resolved a felony, class A misdemeanor, class B misdemeanor, or comparable
criminal offense through a plea in abeyance, diversion agreement, withheld judgment, or other method
whereby a charge was held in suspense during a period of time in which you were on probation or were
obligated to comply with conditions outlined by a court? A traffic offense can be prosecuted as a felony, class
A misdemeanor, class B misdemeanor, or comparable criminal offense. Where this is the case disclosure is
required.
11. Currently, are you aware of any investigation(s), indictment(s), or criminal charge(s) for any crime
in any jurisdiction which are pending against you?
12. Have you EVER been courts martial or discharged other than honorably from any branch of the
armed services?
13. Have you EVER been required to register as a sex offender?
14. Have you EVER had a judgment entered against you in a civil court or in a bankruptcy court on the
basis of fraud, misrepresentation, or deceit, or in any matter related to the purchase, sale, management,
finance, loan origination, or valuation of real estate?
15. Have you EVER been found in contempt of court?
YES answers require a detailed letter of explanation and copies of all court documents including charging and judgment
documents; court dockets; and proof of completion of probation and restitution orders and payment of fines and judgments.
I hereby certify that I have read each disclosure question stated above, that I understand each question, and that I have
answered the questions truthfully and accurately. I agree to be bound by the answers I have provided, and I understand that
I may be sanctioned if any of my answers are found to be misleading or incorrect.
Signature ___________________________________________________ Date ______________________________
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Completed 22 January 2021

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