Fillable MORTGAGE PRE-LICENSE INSTRUCTOR APPLICATION (Utah DRE)

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MORTGAGE PRE-LICENSE INSTRUCTOR 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. 8/19/2014 Page 1 of 2
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 • email: realestate@utah.gov
State of Utah
Department of Commerce
Division of Real Estate
MORTGAGE PRE-LICENSE INSTRUCTOR APPLICATION
Complete and submit this form, the items listed below, and the $75 non-refundable fee by fax, mail, email, or in person.
**APPLICATIONS MUST BE SUBMITTED NOT LESS THAN 30 DAYS PRIOR TO THE DATE OF THE FIRST CLASS**
Name: ___________________________________________ SS#: ____________________ Email: __________________________
Address: _________________________________________________________City/State/Zip: ______________________________
Pre-license School(s): __________________________________________________________ Ph: ___________________________
School Director Signature: ______________________________________________________ Ph: ___________________________
( ) 15-Hour Mortgage Loan Originator Course – Provide evidence of high school diploma or equivalent AND five years experience in
residential mortgage or relevant college-level education related to the course subject AND twelve months full-time teaching experience
or attendance at the Division Instructor Development Workshop AND successfully passing the Mortgage Loan Originator exam.
( ) 40-Hour Lending Manager Course – In addition to items above, provide evidence of at least two years experience in each of the
subjects you intend to teach (including: Management of Residential Mortgage Office, Mortgage Lending Law, Advanced Appraisal,
Advanced Finance) AND successfully passing the Lending Manager exam.
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. 8/19/2014 Page 2 of 2
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 • email: realestate@utah.gov
State of Utah
Department of Commerce
Division of Real Estate
MORTGAGE PRE-LICENSE 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?
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.
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.
Signature ___________________________________________________ Date ______________________________
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MORTGAGE PRE-LICENSE INSTRUCTOR APPLICATION (Utah DRE)

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Completed 22 January 2021

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