Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 030 - BUREAU OF CONSUMER CREDIT PROTECTION › Chapter 500 - CONTINUING EDUCATION REQUIREMENTS FOR INDIVIDUALS REGISTERED AS LOAN OFFICERS, OR LICENSED AS SUPERVISED LENDERS OR LOAN BROKERS › Attachment - ATTACHMENT A

Current through 2024-29, July 17, 2024
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FOR OFFICE USE ONLY
PROGRAM #
							 _____________
CLOCK HRS _____________
Approval
							 Date____________
Approved By_____________
Disapproved
							 Date: ________
Disapproved By: __________
Application for Course Certification:
Loan Officer, Loan Broker or Supervised
Lender Education Program
Office of Consumer Credit Regulation
35 State House Station
Augusta, ME 04333-0035
PH: (207) 624-8527
FAX: (207) 582-7699
INSTRUCTOR CONTACT INFORMATION:
1.
PROGRAM SPONSOR
:
							 ________________________________________________________________________
(School, organization or individual
							 applying for program approval)
2.
CONTACT PERSON
:
							 _________________________________________________________________________
(Person whom the OCCR contact regarding program questions or
							 approval)
Street/P.O. Box _______________________________
							 City_____________________________________________
State: __________
							 Zip __________ Phone: ( ) ___ - __________ FAX ( ) ___ - __________
Email address:
							 _________________________________________________________________________________
							 3.
COURSE REGISTRAR
:
							 _______________________________________________________________________
(Person whom participants will contact for information and or to
							 register for the program)
Street/P.O. Box
							 _______________________________
							 City_____________________________________________
State: __________
							 Zip __________ Phone: ( ) ___ - __________ FAX ( ) ___ - __________
Email address:
							 _________________________________________________________________________________
COURSE INFORMATION:
1.
COURSE TITLE
:
							 ______________________________________________________________________________
2.
INSTRUCTOR
:
							 _______________________________________________________________________________
							 3.
FORMAT:
(please check all that apply)
[]
							 Live/Classroom Setting o Audio/Video
[] Computer (CD or Diskette)
							 [] Distance Learning
[] TV (includes satellite & ITV) []
							 Internet
4.
IS COURSE APPROVED IN OTHER STATES"
_____
							 (If yes, list states:____________)_____________________)
5.
REQUIRED ATTACHMENTS
(Check to confirm that each is
							 attached):
[] Instructor Resume
[] Course
							 Syllabus/Summary
6.
PROGRAM COST
:
							 $________
7.
PROGRAM SCHEDULE:
DATE
LOCATION OF CLASSROOM
CITY
STATE
8.
DESCRIBE HOW ATTENDANCE IS
				ENSURED:_____________________________________________________
9.
DESCRIBE HOW STUDENTS ARE TESTED TO
				MEASURE LEARNING:_________________________________
_____________________________________________________________________________________________________________________________________________________________________________________________
CERTIFIED STATEMENT AND SIGNATURE OF PROGRAM
							 SPONSOR OR AUTHORIZED SCHOOL OFFICIAL.
By my signature, I
							 hereby agree to abide by the requirements and conditions set forth by Rule
							 Chapter 500 of the State of Maine, Office of Consumer Credit Regulation
							 pertaining to continuing education programs and certify that the information
							 contained in this application is accurate and true to the best of my knowledge
							 and belief.
_____________________
							 _________________________________
Date Signature