Post-Licensure Education Form - Ohio Department of ...
Post-Licensure Education Form
Post Licensure Education Requirements: No later than 12 months after the date of issue of a real estate salesperson or broker license, the licensee shall submit to the Division proof of completion of the appropriate post licensure education course.
This form is interactive. You may, before printing it, type your responses directly onto the form. Otherwise, this form must be typewritten or printed legibly in black ink.
Submit this original, completed form, along with a copy of the attendance certificate, to the following address ? Do Not Fax.
Division of Real Estate & Professional Licensing 77 South High Street, 20th Floor Columbus, Ohio 43215-6133
Remember to sign and date this form.
First Name Home Address
Middle Name
Last Name
Date of Birth Home Phone
Please Indicate License Type(s) Held and File Number
BROKER
File #
City Broker Name
State Broker Phone
ZIP Code Broker Fax
SALESPERSON File #
Course Information
Course Provider
Date(s) of Attendance
The Applicant Must Complete the Following Certification
I certify that all of the statements on this application and all of the attached materials are complete and accurate. I understand that any false statement on this form may subject me to criminal prosecution and the loss of my Ohio real estate license.
_______________________________________________________ Signature of Applicant
___________________________________________ Date
77 South High Street 20th Floor Columbus, Ohio 43215 Rev. 11-2017
Anne M. Petit, Superintendent An Equal Opportunity Employer and Service Provider
614-466-4100 Fax 614-644-0584 TTY/TDD 800-750-0750 com.real
REPL-17-0032 (COM3689)
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