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DBPR RE-2070 – Request for School/Instructor Change of Status STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 1940 North Monroe Street Tallahassee, FL 32399-0783 Customer Contact Center: 850.487.1395 FAX: 850.488.8040 www.MyFloridaLicense.com CHECK ACTION REQUESTED Action Requested .. Permit to operate a real estate school -
$135.00 .. Multiple permit - $85.00 .. School Chief Administrator - $85.00 .. Other (please specify) – no charge .. Change permit holder – no charge .. Change of employer for instructor – no charge .. Change of employer for Chief Administrative
Person – no charge APPLICANT INFORMATION Real Estate License Number School Permit Number Instructor/Chief Administrator
Permit Number Applicant Name MAILING ADDRESS Street Address or P.O. Box City State Zip Code (+4 optional) County (if Florida address) Country CONTACT INFORMATION Primary Phone Number Primary E-Mail Address RESIDENCE ADDRESS (IF DIFFERENT THAN MAILING ADDRESS) Street Address City State Zip Code (+4 optional) County (if Florida address) Country SCHOOL LOCATION ADDRESS School Name Street Address City State Zip Code (+4 optional) County (if Florida address) Country
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number Fax Number Alternate E-Mail Address SCHOOL AND INSTRUCTOR QUESTIONS If requesting additional permits, are the additional permits necessary to the conduct of the business of a
real estate school? Yes .. No .. Please note: Additional permits may not be used in a manner likely to be prejudicial to any person,
licensee, or permit holder. If answer to above question is yes, state fully. COURSE/CURRICULA INFORMATION Do you desire this permit in order to conduct a school? Yes .. No .. If yes, identify the courses that will be offered below: Real Estate .. Sales Associate Pre-license .. Broker Pre-license .. Sales Associate Post-license .. Broker Post-license .. Instructor Continuing Education .. Continuing Education – Classroom .. Continuing Education – Correspondence .. Core Law .. Escrow Management Appraisal .. Appraisal Pre-certification .. Appraisal Continuing Education .. USPAP/Florida Law Update .. Appraisal Instructor Continuing Education I affirm that I have provided the above information completely and truthfully to the best of my
knowledge. Applicant Sign Here: Date:
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