Private Real Estate School Branch Application


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PLEASE REVIEW THE STATUTE AND RULES PRIOR TO COMPLETING THIS FORM


Character of School Owner(s)/Official(s)

The following questions apply to the school owner, school director, & the following persons involved with a business entity that owns the school: Corporation major officers & corporate shareholders with 10% or more ownership interest in any class of stock; limited liability company members & managers; partnership general partner & limited partners with a 10% or more ownership interest; & for other business entities, the major officers & any person with a 10% or more ownership interest.

If “Yes”, provide a copy of the court judgment, release from parole or probation, and a complete explanation from each affected person. *
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Person #1* (required)

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Person #2

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If “Yes”, provide a copy of the licensing agency’s order and a complete explanation from each affected person. *
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Person #1* (required)

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Person #2

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Fire Inspection Report

A CURRENT fire inspection conducted by the appropriate fire department is required for each proposed classroom location. If the inspection was conducted more than a year prior to submission of your school application, an official statement from the inspecting authority regarding the effective period of their inspection report (e.g., 2 years or 3 years) will be necessary. If any violations were noted in the original inspection report, you must attach a subsequent inspection report that shows corrected violations or official communication from the inspector certifying that noted violations have been corrected. Applicant must certify that school facilities and equipment are in compliance with all applicable local, state and federal law and regulations regarding health, safety, and welfare, including the Americans with Disabilities Act. *
*Accepted File Types: .tiff .tif .jpeg .jpg .txt .pdf .docx .doc .png
*Max file upload size 10MBs total.

Total File Upload Size: 0.000*Mb

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Signature & Certification

The undersigned declares that he/she has read the foregoing application and that the information provided therein, including any attachments, is true and correct to the best of his/her knowledge and belief, and that, if other than the sole owner, he/she is duly authorized by the applying business entity to file this application.

(Type your name)

Date Signed

6/18/2019

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