Rev.12/05/2013 Page 2 of 2
Make check for $75 payable to the Utah Division of Real Estate (add $50 late fee if after expiration date.)
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
PRE-LICENSE INSTRUCTOR RENEWAL APPLICATION
Yes No
5.
Since your last renewal, have you 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?
6. Do you have knowledge of any complaint, investigation, or disciplinary action CURRENTLY
ongoing or pending against you by a regulatory or licensing body?
7. Since your last renewal, have you 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.
8. Since your last renewal have you 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.
9 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?
10. Since your last renewal, have you been courts martial or discharged other than honorably from any
branch of the armed services?
11. Since your last renewal, have you been required to register as a sex offender?
12. Since your last renewal, have you 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?
13. Since your last renewal, have you 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.
I hereby certify that the information provided with this application, including the answers provided above, is true and correct.
Signature ___________________________________________________ Date ________________________
