Instructor Qualification Form - Mid Valley Association of REALTORS®

Instructor Qualification Form

INSTRUCTIONS

Before offering a real estate continuing education course that is eligible for credit required under ORS 696.174, the Certified Continuing Education Provider must ensure that the instructor who teaches a continuing education course offered for credit meets the instructor requirements contained in ORS 696.186.

The Certified Continuing Education Provider must ensure that the instructor completes and signs this form, and must maintain the form as part of their record-keeping. OAR 863-020-0060 and 863-020-0050

The Agency does not certify instructors. DO NOT send this form to the Agency unless requested by the Agency.

CERTIFIED CONTINUING EDUCATION PROVIDER

Provider: Mid-Valley Association of REALTORS® Provider Number: 1154

Fields marked with an * are required.

First Name *

Last Name *

Title / Position *

Short Instructor/Company Bio:

Company *

Phone *

Email *

Address Line 1 *

Address Line 2

City *

Postal Code *

Instructor Qualifications *

Check the box(es) below that describes your qualifications for teaching a real estate continuing education course. ORS 696.186

A bachelor's degree and two years of experience working in a field related to the topic of the course

Six years of experience working in a field related to the topic of the course

A total of six years of any combination of college-level coursework and experience working in a field related to the topic of the course

A designation by a professional real estate organization, as defined in OAR 863-020-0060(5), and two years of college level coursework

A designation as a Distinguished Real Estate Instructor by the Real Estate Educators' Association

Certification or approval in good standing as a real estate instructor for the same or a similar course topic in any other state or jurisdiction

INSTRUCTOR QUALIFICATIONS- continued *

REQUIRED: Describe below in sufficient detail how you have met the above qualifications. You may attach additional pages if needed.

Attach file if necessary:

20MB max

INSTRUCTOR ATTESTATION *

I hereby attest and affirm that the above information is true and accurate, and that: I have not had a professional or occupational license related to the topic of the course revoked for disciplinary reasons; I do not have a professional or occupational license related to the topic of the course that is currently suspended for disciplinary reasons; and I have not been determined by a state court, an administrative law judge, or a final agency order to have violated any statute, rule, regulation, or order pertaining to real estate activity in this or any other state in the preceding five years.

Date *

Please List Course Topic/Name(s): *

In a few sentences, please summarize the course(s):

Upload any materials you need printed or shared with attendees:

20MB max

Additional comments, requests, or questions:

Recording *

Does Mid Valley Association of REALTORS® have your permission to record your presentation and use it on our website/social media/emails to membership...etc?

Yes

INSTRUCTIONS

CERTIFIED CONTINUING EDUCATION PROVIDER

Provider: Mid-Valley Association of REALTORS® Provider Number: 1154

Please verify that you have checked the “I'm not a robot” checkbox.

REQUIRED: Describe below in sufficient detail how you have met the above qualifications. You may attach additional pages if needed.