New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Professional Engineers and Land Surveyors
Home Inspection Advisory Committee
124 Halsey Street, 3rd Floor, P.O. Box 45043
Newark, New Jersey 07101
(973) 504-6233
Continuing Education Approval Form
Please complete this form if you are a program sponsor seeking Committee approval pursuant to N.J.A.C. 13:40-
15.14(g).
Sponsor: _________________________________________________________________________________________
Address: _________________________________________________________________________________________
Street address City State ZIP code
Name of contact person: ___________________________________ Telephone number: _______________________
(include area code)
Website: ______________________________________________ E-mail address: _____________________________
Course name: ____________________________________________________________________________________
Course date(s):_____________________________________________________________________________________
Total length of course/seminar in hours: ____________________
(In order to receive one continuing education credit, a course/seminar must be 60 minutes of class time with a
minimum 50 minutes of instructions.) (Pursuant to N.J.A.C. 13:40-15.2)
Sponsor Responsibilities:
Pursuant to N.J.A.C. 13:40-15.14(g)(3) and (4), each sponsor shall monitor the attendance at each approved course,
seminar or program and furnish to each enrollee a verication of attendance that includes: 1) the name and license
number of the attendee; 2) title, date and location of the course; 3) number of hours/credits; and 4) the name and
signature of the responsible party. Each sponsor shall also solicit course, seminar or program evaluations from both
the participants and the instructors.
Instructor’s Name(s): ______________________________________________________________________________
(Attach a copy of Curriculum Vitae (resume) for each instructor.) (Pursuant to N.J.A.C. 13:40-15.14(g)2ii)
The curriculum vitae of the lecturer, including the specic background
which qualies the individual as a lecturer
of repute in the area of instruction, must be submitted.
Course Site Location: ______________________________________________________________________________
Attach a copy of the Course Description:
A detailed description of course content and estimated hours of instruction must be submitted. (Do not send course
outlines.) (
Pursuant to N.J.A.C. 13:40-15.14(g)2i)
If applicable, include the number of hour(s) the course includes instruction in the following areas:
Report Writing:______ Ethics: ______ Rules governing the practice of home inspection: ______.
Submitted by: ________________________________________________________________________________________
Address: _________________________________________________________________________________________
Street address City State ZIP code
Sponsors must submit a fee of $100.00 to cover all courses offered during the biennial licensing period. (
Pursuant
to N.J.A.C. 13:40-15.14(g)5)
Ofce Use Only
Approved by Committee: Yes No Date: _________________________________
Approved by: _________________________________
Course number: _______________________________ Total Continuing Education Units: _________________
