WNY SCHOOL OF REAL ESTATE INTERNET TRAINING CLASS
COURSE TITLE: ________________________________________________________________
** THIS FORM SHOULD BE PRINTED THEN MAILED TO US AT THE ADDRESS BELOW **
Instructions: *Complete this form in its entirety and forward to the Educational Coordinator,
Western NY School of Real Estate, P.O. Box 702, East Amherst, NY 14051. YOUR COMPLETE NAME: ________________________________________________________
STREET ADDRESS:______________________________________________________________
CITY, STATE, ZIP CODE:_________________________________________________________
PHONE NUMBERS:______________________________________________________
LICENSE REGISTRATION NUMBER:________________________________ LICENSE EXPIRATION DATE:
OFFICE INFORMATION
OFFICE NAME, ADDRESS & PHONE #__________________________________
FAX #:____________________________
YOUR EMAIL ADDRESS:______________________________
LAST FOUR DIGITS OF YOUR SOCIAL SECURITY NUMBER: ___________
PROGRAM HIGHLIGHTS:
The course noted above is NYS approved for real estate agent and broker continuing education only. The course is
not considered to have been completed until YOU physically contact us and attest that you have satisfactorily
completed 100% of the total amount of time approved AND ALL questions & components must be completed in their entirety. Students will not receive a grade other than "S" (Satisfactory) or "U" (Unsatisfactory). NYS does not allow
testing as a prerequisite to successfully earn NYS CE credit as ATTENDANCE & your active PARTICIPATION in the
course is needed to satisfy the two-year education requirements according to the regulations. YOU MUST FINISH
THE COURSE PRIOR TO YOUR LICENSE RENEWAL DATE if you are doing it for license renewal. Please note:
the questions, tests, exams and threaded discussions completed throughout the INTERNET COURSE noted above
must be completed (as this is part of the timing mechanism) - otherwise you will get done TOO FAST and not earn
your CE credit. If our timing mechanism indicates that less than the statutory time has been completed - you will be
advised by the Educational Coordinator that more work on your part may be necessary. The course must be
registered for BY CALLING THE SCHOOL AND PHYSICALLY REGISTERING with one of our staff members. Once
registration is complete, you can begin and end the course anytime you wish (based on meeting the attendance req.
above). A certificate of completion and transcript of your official record will be mailed out in approx. 30 days or less
(remember - you do not need the physical certificate in your possession to renew your license - but you should keep
it in a safe place in case you are randomly audited by the State at some point in the future). Course certificates may
be withheld for non-payment of any fees.
I certify that the information provided herein is accurate and complete. I also attest by my
signature below that I am doing the course personally for the entire duration for the full
number of credit hours being granted. Under penalties of fraud, any change in this agreement
will be brought to the Educational Coordinators attention immediately.
Student Signature & Date:___________________________________________
Phone: (716) 639-9009
The State no longer accepts faxed signatures - originals are required - be sure to mail to us!
(Starts with a 40 or 30 # then the first 2 letters of your last name, seven numbers follow this, i.e. 40BR1234567)