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.