Course Provider Application Form - South Carolina Appraisers Board printable pdf download

SOUTH CAROLINA APPRAISERS BOARD

COURSE PROVIDER APPLICATION

Please return to: SC LLR- Appraisers Board, P.O. Box 11847, Columbia, SC 29211-1847

I. PROVIDER INFORMATION

PROVIDER NAME: _________________________________ TELEPHONE: _________________________________

MAILING ADDRESS: ______________________________________________________________________________

CITY, STATE, ZIP CODE:

________________________________________________________________________

E-MAIL: ___________________________________________

FAX: _____________________________________

CONTACT PERSON: ______________________________________________________________________________

WEB PAGE ADDRESS: ____________________________________________________________________________

REQUIRED: FEDERAL I.D. NUMBER: ____________________________________

II. RECORD KEEPING PROCEDURE

METHODS OF RECORD MAINTENANCE: (Explain your procedure for maintaining student's records for a minimum of

five (5 years.)

_________________________________________________________________________________________________

III. THE AMERICAN WITH DISABILITIES ACT (ADA)

Any private entity that offers courses or examinations related to licensing for professional or trade purposes must offer

such courses or examinations in a place and manner accessible to all persons, or offer alternative but equal

arrangements. This may include the provision of auxiliary aids and services for persons with disabilities. For more

information contact your Equal Employment Opportunity Commission.

IV. ACKNOWLEDGEMENT OF RESPONSIBILITIES

I am applying for approval to provide appraisal qualifying and/or continuing education courses, and I certify under penalty

or perjury that all statements and materials are true and correct, and that nothing has been withheld which would influence

a complete evaluation of this application. I have read and agree to comply with the South Carolina Real Estate Appraiser

Registration, License and Certification Act and Regulations of the SCLLR – Real Estate Appraisers Board.

_______________________________________________

_________________________

Signature and Title

Date

V. ENCLOSURES

ENCLOSED WITH THIS APPLICATION ARE:

A copy of enrollment agreement (refer to Regulation Section 137-900.07)

A sample Certificate of Completion (refer to Regulation Section 137.900.05(M).)

Currently there is no fee associated with this application.

Personal information provided in this application may be subject to public scrutiny or release under the South

Carolina Freedom of Information Act or other provisions of Federal and State law.

Signature: ____________________________

Date: _______________________

AB Form

Rev 3/09

Previous editions of this form are obsolete.

Course Provider Application Form - South Carolina Appraisers Board