Fill - FORM 528 TIMESHARE CONTINUING EDUCATION: REAL ESTATE DIVISION (Nevada Real Estate Division)

STATE OF NEVADA

DEPARTMENT OF BUSINESS AND INDUSTRY

REAL ESTATE DIVISION

03/20/2017 Page 1 of 10 528

FORM 528 – TIMESHARE CONTINUING EDUCATION

COURSE APPLICATION

Instructor Information

13. List instructor names below:

Individual instructor application for each instructor is required.

Date _________________________________________

Sponsor Information

1. Name of Sponsor:

2. Mailing Address:

City, State & Zip:

3. Telephone:

Fax:

4. E-mail:

URL:

5. Contact Person:

Course Information

6. Course Title:

7. Requested hours of classroom instruction or self paced study, if distance education:

8. Course Objectives / Learning Outcomes:

9. Course Fee Range: $

10. Select the qualifying standards in NAC 119A.400 under which this course is being submitted for approval:

1a

1b

11. Select 1 Delivery Method: Classroom Instruction

Distance Education (select 1 below)

a. Internet b. Correspondence c. Other ______________________

12. State subject area of course, i.e. 1031 exchange, financing, marketing, supervision, calculators, etc.:

03/20/2017 Page 2 of 10 528

Retention of continuing education records

Sponsor verifies that attendance records will be retained in accordance with NAC 119A.380

at Sponsor’s

location address given below.

Written notice of any change in location must be given to the Real Estate Division, Education Section.

14. Address of location at which records will be held:

(City, State,Zip)

(Printed Name of Authorized Records Custodian)

(Signature of Authorized Records Custodian)

Regulatory Compliance

15. Course application fee is $150 per application. Amount enclosed : $

“I declare under penalty of perjury under the laws of the State of Nevada that the foregoing is true and correct.”

(Print Name)

Executed on

(Date)

(Signature of person authorized to submit application)

INCOMPLETE SUBMISSIONS COULD RESULT IN DELAY OR DENIAL OF APPLICATION.

COURSE APPLICATION FEE IS NON-REFUNDABLE.

If course is by distance education delivery, you must also complete:

1. Distance Education Questionnaire (required, unless course delivery is ARELLO certified);

2. Application for Secure Electronic Method of Administering Final Exam, if applicable;

3. Certificate of Test Proctor, if applicable.

03/20/2017 Page 3 of 10 528

TIMESHARE CONTINUING EDUCATION

INSTRUCTOR APPLICATION

1. Name of Applicant:

Mailing Address:

City, State & Zip:

Business Phone:

Fax Number:

Applicant’s E-Mail Address:

2. Name and address of Sponsor for which the applicant will instruct:

3. Title of Course which the applicant will instruct:

4. PROOF OF QUALIFICATION MUST BE ATTACHED to include:

 Detailed resume defining dates (from-to) of schooling and experience. Describe experience in the field in which

applicant is applying to instruct so that resume clearly shows how applicant is qualified to teach subject matter of

course per NAC 119A.380;

 Copies of applicable documents (licenses, certificates, etc).

QUESTIONS 5, 6, AND 7 MUST BE ANSWERED BY APPLICANT:

5. Have you ever been refused approval of a license or certificate by any Federal, State, County or City agency?

Yes No If yes, attach an explanation.

6. Has any license or certificate held by you been suspended, revoked or subject to discipline?

Yes No If yes, attach an explanation.

7. Have you ever been subject to disciplinary action by any Federal, State, County or City agency?

Yes No If yes, attach an explanation.

INCOMPLETE SUBMISSION COULD RESULT IN DELAY OR DENIAL OF APPLICATION.

I declare under penalty of perjury under laws of the State of Nevada that the foregoing attached statement consisting

of __ pages is true and correct.

Executed on:

, 20

(Date) (Signature)

(Print Name)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

FOR NRED INTERNAL USE ONLY

Date: Approved / Denied By:

03/20/2017 Page 4 of 10 528

DISTANCE EDUCATION QUESTIONNAIRE

MUST BE COMPLETED IF SPONSOR DOES NOT HAVE DISTANCE EDUCATION CERTIFICATION

See NAC 645.443

I. What is your mission statement?:

II. Describe the design of the course:

III. What are your procedures for updating the course:

IV. Describe the type and frequency of interactivity of the instruction with the students:

V. How does the instruction provided teach mastery of the materials?:

VI. What support services are available to students?:

VII. How was a time study of the range of instructional hours for this course completed?: Justify the

number of hours requested to be approved for this course.

03/20/2017 Page 5 of 10 528

DISTANCE EDUCATION QUESTIONNAIRE

Page 2

VIII. Describe and document how each module of instruction has:

a) At least one learning objective.

b) A structured learning method to enable the student to achieve the learning objective.

c) A method of assessment of the student’s performance during instruction.

d) A method of remediation if student is deficient in mastering the course material to repeat the

course until the student understands.

e) A complete syllabus or student instruction manual (or both) provided in written form which

includes accurate and clearly stated information about admissions, progression, completion,

criteria, dismissal and any applicable licensing requirements.

03/20/2017 Page 6 of 10 528

APPLICATION FOR SECURE ELECTRONIC METHOD OF ADMINISTERING

FINAL EXAM FOR DISTANCE EDUCATION COURSES

NAC 645.443 allows for a written final examination to be administered by a secure electronic method in lieu of

a proctored exam.

Describe your proposal for administering testing in electronic format. Your proposal should detail the

procedures, methods and components you plan to utilize to secure the electronic format and the test security to

assure that the person testing is the student.

Describe the elements and procedures you plan to utilize in grading the exam. Describe how the student will be

notified of a pass or fail grade. What will be necessary for the student to re-test?

Please provide copies of exam(s) and answer key(s). NAC 645.403(9)

03/20/2017 Page 7 of 10 528

CERTIFICATE OF TEST PROCTOR

Proctor Verification

Submitting this completed form will allow

to release the exam to the proctor via fax.

(Name of school)

Nevada Administrative Code, NAC 645.443 requires that a student who enrolls in a distance education program must pass a

proctored, written examination. The proctor (someone over 18 who is not related to the student / see section 1 below) must complete

this form and fax the completed form to

.

(Name of school) (Phone Number)

All proctor signatures are required to be notarized. This insures the proctor is a real and valid person. All sections of this form must

be completed for a test to be sent to the proctor.

Instructions to proctor: Complete this form then email or fax the form

will email or fax the exam to be proctored

(Name of school)

Name of the course taken

(Use the students receipt or the title of the workbooks)

Name of the student taking the test

The proctor certifies that:

1. I am a disinterested third party in the administration of this examination. I am not related by blood, marriage or any other

relationship to the examinee that would influence me from properly administering the examination. I am not a real estate

licensee nor am I affiliated with a real estate brokerage firm.

2. The student taking the exam will show me positive photo identification prior to taking and completing the examination.

3. The enclosed examination will be administered under my supervision on the following date: ___________________.

4. The student received no assistance in taking the examination.

5. The test should be sent to my attention at: Fax _________________ or Email __________________________________ .

6. may contact me with questions via phone at the following number: _________________.

(Name of school)

7. I will not permit the examination to be compromised, copied, or recorded in any way or by any method.

8. After examination is administered, I will fax/email completed examination to your school.

Printed Name of Proctor Signature of Proctor

Address City State Zip

State of _______________ } (Notary Seal)

}SS

County of _______________ }

Subscribed and sworn to before me this _____ day of _______________, 20____.

________________________________ My appointment expires on _______________.

Public Notary

03/20/2017 Page 8 of 10 528

CONTINUING EDUCATION

CONTENT/ INSTRUCTOR EVALUATION REPORT FORMS

FORM 612A

OR

FORM 612B

03/20/2017 Page 9 of 10 528

03/20/2017 Page 10 of 10 528

Form 528 Checklist

Sponsor

Checkbox

Check for all items that have been completed, are included or

applicable before submitting application to the Division.

NRED

Checkbox

Sponsor Information completed

Course Information completed

Course objectives

Qualifying Standards selected

Delivery Method

Subject Area of Course stated

Retention of Records – completed and signed

$150 Fee

Form 528 completed, signed and dated

Instructor Applications (resumes, licenses, certificates, etc.)

ARELLO Certification or Distance Education Questionnaire

Application for Secure Electronic Method of Administering Final Exam

(if applicable)

Certificate of Proctor (if applicable)

Evaluation Report Form

Sample Attendance Sheet (if applicable)

Sample Certificate of Attendance

Timed 2 to 3 point Content Outline

Course Materials (plus videos/CDs as applicable)

Sample Student Handouts

Sample Refund/Cancellation Policy

Description of physical facility (if applicable)

Copyright Authorization Letter (if applicable)

Exams, Quizzes and Answers (if applicable)

Submit completed application, with materials and fee to:

Education Section, Real Estate Division

3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

FOR NRED INTERNAL USE ONLY

Duplicate Course:  Yes  No CE# ____________ Duplicate Title:  Yes  No CE# _____________

Application complete and accepted:  Yes  No Date: __________________ Initials: _________

Fill Online, Printable, Fillable, Blank FORM 528 TIMESHARE CONTINUING EDUCATION: REAL ESTATE DIVISION (Nevada Real Estate Division) Form

Related forms

Fillable FORM 528 TIMESHARE CONTINUING EDUCATION: REAL ESTATE DIVISION (Nevada Real Estate Division)

Fill Online, Printable, Fillable, Blank FORM 528 TIMESHARE CONTINUING EDUCATION: REAL ESTATE DIVISION (Nevada Real Estate Division) Form

Related forms

First 20 documents completely FREE!