Non-Certified Continuing Education Credit Request Form
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1State of Utah
N
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C
E
C
R
ON
CERTIFIED
ONTINUING
DUCATION
REDIT
EQUEST
Department of Commerce
Division of Real Estate
Applications for course credit should be submitted to the Division of Real Estate no later than 30 days prior
to licensees expiration date. Please complete and submit this form with all attachments listed below.
**
**
CE CREDIT IS GRANTED BASED ON THE COURSE SUBJECT MEETING SPECIFIC INDUSTRY CE REQUIREMENTS
Industry:
( ) Appraisal
( ) Real Estate
Name: __________________________________________________
License No. _______________________________________
Address: ________________________________________________ City: ______________________State: ________Zip: ________
Ph: ______________________________________________ Email: ___________________________________________________
Required items must be included in order to have education approved.
If these items are not included your request will be denied.
( ) A copy of the Course Curriculum or Outline from the Course Provider.
( ) A copy of the Education Certificate from the Course Provider.
Please do not send original documents as we are unable to return them to you.
Note
: No correspondence/home study courses will be accepted.
Course Title: _________________________________________________________________________________________________
Hours requested: __________ Course Completion Date: _______________________ Core: Yes ( ) No ( )
Course Provider: _______________________________________________
Ph: _________________________________________
Date Reviewed by DRE: ____________ By:________ ( ) Denied ( ) Approved – CE Hours _________ Core: Yes ( ) No ( )
Course Title: _________________________________________________________________________________________________
Hours requested: __________ Course Completion Date: _______________________ Core: Yes ( ) No ( )
Course Provider: _______________________________________________
Ph: _________________________________________
Date Reviewed by DRE: ____________ By:________ ( ) Denied ( ) Approved – CE Hours _________ Core: Yes ( ) No ( )
Course Title: _________________________________________________________________________________________________
Hours requested: __________ Course Completion Date: _______________________ Core: Yes ( ) No ( )
Course Provider: _______________________________________________
Ph: _________________________________________
Date Reviewed by DRE: ____________ By:________ ( ) Denied ( ) Approved – CE Hours _________ Core: Yes ( ) No ( )
Course Title: _________________________________________________________________________________________________
Hours requested: __________ Course Completion Date: _______________________ Core: Yes ( ) No ( )
Course Provider: _______________________________________________
Ph: _________________________________________
Date Reviewed by DRE: ____________ By:________ ( ) Denied ( ) Approved – CE Hours _________ Core: Yes ( ) No ( )
I hereby certify that the information provided with this request is true and correct and that I have completed all elements of this course.
Signature ___________________________________________________
Date ______________________________
*Please check your Online RELMS account for approved credit.
Approved credit will be banked within 30 days of receiving this application.
Rev. 04/11
160 East 300 South, PO Box 146711, Salt Lake City, UT 84114-6711
Telephone (801) 530-6747 • Facsimile (801) 526-4387 • Internet:
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