Application for Original Education Provider Certification

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Administrative/Principal Office of Education Provider

Education Director

Courses To Be Offered
Note: Certification as an Education Provider authorizes the EP to conduct real estate courses. However, prior to advertising or offering any courses, the EP must submit form REC 7.33 – Approval of a Real Estate Education Course in order to obtain approval for each course to be offered.
Broker Prelicensing Course
Broker Postlicensing Courses
What Postlicensing Courses will the Education Provider be conducting? (30 hours minimum, per course, Select all that apply)*
Continuing Education Courses

Provider Locations
Administrative/Principal Location*
Location #2*
Location #3*
Location #4*
Location #5*
Location #6*
Location #7*
Location #8*
Location #9*
Location #10*

Education Provider Policies & Procedures Disclosure (PPD)

Upload a copy of the PPD including all items on the PPD checklist.*
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2Mbs

Consent to Service

If applicable, upload a copy of the Consent to Service Process and Pleadings (REC 1.03).*
This requirement applies ONLY to Foreign (Out-of-State) Corporations, Limited Liability Companies, and Limited Partnerships.
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2Mbs

Additional Documentation

Attach any additional documentation that supports this application.
*Accepted File Types: .txt .pdf .docx .doc
*Max individual file upload size is 2Mbs

Read the Public Notice Statement. Click the box to certify that you have read the statement, and select Yes or No in response to the question regarding investigations. If you select Yes, you will be required to provide information regarding the case(s). If you have questions regarding this section, please direct them to the North Carolina Industrial Commission. Contact information is provided on the page.

As required by the NC state legislature in NCGS § 143-765, effective January 1, 2018, in order to apply for or renew an occupational license, permit, or certification, the applicant must certify that they have read and understand the public notice statement from the Employee Classification Section of the State Industrial Commission and must disclose any investigations for employee misclassification.

Public Notice Statement
required by N.C. Gen. Stat. § 143-764(a)(5), effective December 31,2017

Any worker who is defined as an employee by N.C. Gen. Stat. §§ 95-25.2(4)(NC Department Of Labor), 143-762(a)(3)(Employee Fair Classification Act), 96-1(b)(10)(Employment Security Act), 97-2(2)(Workers’ Compensation Act), or 105-163.1(4)(Withholding; Estimated Income Tax for Individuals) shall be treated as an employee unless the individual is an independent contractor. Any employee who believes that the employee has been misclassified as an independent contractor by the employee’s employer may report the suspected misclassification to the Employee Classification Section within the North Carolina Industrial Commission.

Employee Classification Section
North Carolina Industrial Commission
1233 Mail Service Center
Raleigh, NC 27699-1233
Telephone: (919) 807-2582
Fax: (919)715-0282

Employee misclassification is defined as avoiding tax liabilities and other obligations imposed by Chapter 95, 96, 97, 105, or 143 of the North Carolina General Statutes by misclassifying an employee as an independent contractor.N.C. Gen. Stat. § 143-762(5)

Application Fees
The classroom location fee must be paid for each proposed classroom location; however, the course fees need only be paid once for each Education Provider. [See Rule 58H .0202 ] All application fees are nonrefundable.
Provider Location(s):$200 per location:
Conduct Broker Prelicensing Course ($40):
Conduct Broker Postlicensing Courses ($40 x 3 = $120):

Form Processing
Any Education Provider Certifications, Branch Locations, and/or courses approved now for the current license year must be renewed between May 15 - June 30 to assure continuous approval into the license year beginning July 1.

Signature & Certification

I certify that I have read the foregoing application and that the information provided therein is true and correct to the best of my knowledge and belief. I also certify that all courses conducted by this education provider shall be conducted in compliance with General Statute 93A-Article 3 and the Commission rules of Subchapter 58H.

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This form is not meant to be printed. If you have already completed the form please use the submit button at the bottom to send the form directly to the Commission.