Course Registration Form

Broker Course Application

Fill out the form carefully for review. After review of your application, If accepted for the class, a registration link will be sent to your email.
Student Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Cell Number*
Work Number
Have you every been convicted of or entered a plea of guilty or nolo contendere (no contest) to any felony, misdemeanor or other criminal offense, including any offense for which you have received a pardon, in any jurisdiction?*

YesNo
Are any criminal charges pending against you?*

YesNo
Do you have any impairment related to drugs or alcohol that would limit your ability to undertake the practice of real estate in a manner consistent with the safety of the public?*

YesNo
Are you actively licensed as a real estate agent in Delaware (or an agent/broker in a different jurisdiction) and have been for at least five continuous years prior to your application?*

YesNo
Have three of the five previous years been spent actively practicing real estate (i.e., representing buyers or sellers in a transaction)?*

YesNo
Do you have documentation of at least 30 sales or lease transactions that you completed during the five years immediately prior to yur application? (NOTE: timeshare or property management transactions DO NOT satisfy this requirement.)*

YesNo
I certify that the information in this application is complete and true. I understand that the intentional inclusion of false or fraudulent information may result in dismissal from the class. Please sign below.
Signature*

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Broker Course Application