Fillable REAL ESTATE ASSOCIATE INSTRUCTOR APPLICATION (Arkansas Real Estate Commission)

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REAL ESTATE ASSOCIATE INSTRUCTOR APPLICATION (Arkansas Real Estate Commission)

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ARKANSAS REAL ESTATE COMMISSION
Phone: (501) 683-8010 Fax: (501) 683-8020
REAL ESTATE ASSOCIATE INSTRUCTOR
APPLICATION
AREC 6/2014
Instructions: is application must be completed, signed and notarized. Each question must be answered
and the necessary documentation and fees attached or the application will be returned to the applicant.
Applicant’s Name: _____________________________________________________________________
(First Name) (Middle Name) (Last Name)
Home Address: ____________________________________________ PO Box: ____________
Personal Phone: ______________________ Email Address: ___________________________________
Highest level of education completed: ______________________ Completion date: ________________
Name and location of school: ____________________________________________________________
City: __________________________________ State: __________ Zip: _____________
Real Estate License Number: _________________________ Status: Active Inactive Expired
Real Estate Firm: _______________________________________ Firm Phone: ___________________
License Issuance Date: _______________________ License Expiration Date: ____________________
Firm Address: ____________________________________________ PO Box: ____________
City: __________________________________ State: __________ Zip: _____________
PART I - PERSONAL INFORMATION
PART II - REAL ESTATE FIRM INFORMATION
Return to: Arkansas Real Estate Commission | 612 South Summit St | Little Rock, AR 72201
COMMISSION USE ONLY
Receipt # ______________
Date Paid ______________
Have you ever been convicted of or plead guilty or nolo contendere to any crime other than a trac viola-
tion? _____YES _____ NO Being convicted shall include all instances in which a plea of guilty or nolo con-
tendere or nding of guilt is the basis for the conviction, and all proceedings in which the sentence has been
deferred or suspended. (If responded Yes, provide a written report of the conviction which should include
the date of the oense and of the conviction, the name and address of the court, the specic crime of which
convicted or to which a guilty plea or nolo contendere [no contest] was entered, the ne, penalty and/or other
sanctions imposed, and copies of the charging document and judgement of conviction or other disposition
including probation or suspension of sentence. All requested documents and reports must be included with
the application.)
Gender: ___________________________
Print Form
Return to: Arkansas Real Estate Commission | 612 South Summit St | Little Rock, AR 72201
ARKANSAS REAL ESTATE COMMISSION
Phone: (501) 683-8010 Fax: (501) 683-8020
REAL ESTATE ASSOCIATE INSTRUCTOR
APPLICATION (cont’d)
PART III - SCHOOL INFORMATION
PART IV - ADDITIONAL REQUIRED INFORMATION
Name of School: _______________________________________________________________________
School Address: ____________________________________________ PO Box: ____________
City: __________________________________ State: __________ Zip: _____________
2. Driver’s License/Birth Certicate
1. Check for $200 made payable to AREC
Sales pre-license Sales post-license
Broker post-license
Continuing Education
Distance Education
Broker pre-license
Instructor License Number: _________________________
Principal Instructor Name (Please Print)
Principal Instructor Signature Date
_______________________________________
________________________________________________________
I accept the responsibility for the actions of the above instructor and give consent for instructor to instruct at the school.
PRINCIPAL INSTRUCTOR INFORMATION:
3. Type of education instructor will teach (Include corresponding training certicates if not on le w/
AREC):
PART V - NARRATIVE OF EXPERIENCE (SEE LAST PAGE)
By placing my signature below, I certify that I have read each paragraph above and acknowledge each disclo-
sure, that all information provided in this application is true and correct, and that the Arkansas Real Estate
Commission may rely on its truthfulness in considering this application.
Notary Public Signature
Notary Seal
State of ____________________________
County of __________________________
Subscribed and sworn before me, a No-
tary Public, in and for the county and
state aforesaid, this the _________ day of
______________________, 20____.
Applicant’s Signature Date
___________________________________________
______________________________________________________________
NO REQUEST WILL BE PROCESSED WITHOUT A NOTARIZED SIGNATURE
Return to: Arkansas Real Estate Commission | 612 South Summit St | Little Rock, AR 72201
ARKANSAS REAL ESTATE COMMISSION
Phone: (501) 683-8010 Fax: (501) 683-8020
REAL ESTATE ASSOCIATE INSTRUCTOR
APPLICATION (cont’d)
PART V - NARRATIVE OF EXPERIENCE
Use the space below to provide the Commission with a summary of why you are qualied to be an Instructor.
Please refer to specic challenges, unique situations and/or victories encounterd within your employment
experience and expound upon their relevance in preparing you for licensure as a Associate Instructor. Attach
addtional sheets if necessary.
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REAL ESTATE ASSOCIATE INSTRUCTOR APPLICATION (Arkansas Real Estate Commission)

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Completed 28 December 2021

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