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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. 07/29/2013
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
REAL ESTATE CONTINUING EDUCATION INSTRUCTOR RENEWAL NOTICE
Please complete (type or neatly print) and submit this form, the items listed below, and $50
to the Division by fax, mail, or in person.
Name: ________________________________________________________
Address: _____________________________________________________________________________________________________
Phone: ________________________________ E-mail: _______________________________________________
License Number: ________________________________ Expiration Date: ________________________________
Provide the following information regarding each course you intend to teach:
Course Title: _________________________________________________________________________________________________
Course Provider: ______________________________________________________________________________________________
During the two years, I have taught a minimum of one class in each course I intend to teach.
Following is the explanation of why I have not taught the above course(s). I have maintained my level of expertise in the
subject matter of the course (s) by:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
YES NO
1. Since your last renewal, have you had a professional or occupational credential (license, registration,
certification, or similar authorization to work in a professional or occupational capacity) denied, revoked or
suspended?
2. Since your last renewal, have you 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?
3. Since your last renewal, have you 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 for any reason?
4. Since your last renewal, have you 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)?
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
( ) Check ( ) Visa ( ) MasterCard ( ) American Express
Make checks payable to: Utah Division of Real Estate
Card # ____________________________________ Expires __________
Signature ___________________________________________________
OFFICE USE ONLY
Date Reviewed _______________ By _______
( ) Denied ( ) Approved
Certification _________________ Exp. ______
Rev. 07/29/2013
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
REAL ESTATE CONTINUING EDUCATION INSTRUCTOR RENEWAL NOTICE
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 purchase, sale,
management, finance, loan origination, or valuation of real estate?
13. Since your last renewal, have you 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 questions 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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