Please click here to print out this form. Then fax or mail it back to enroll.

 

 


 

Phone: 404-836-4040
Fax: 404-236-7139
SALESPERSON'S PRE-LICENSE COURSE
ENROLLMENT APPLICATION

Control #: _______________________________
 (for administrative use only)

Date:___________________
 
Select Format: Day Evening Weekend Computer Online or CD (Circle one)

Course Beginning Date: ___________________________   Location: ___________________________________
Student Name: _________________________________________________ Date of Birth: ________________
 
(Last) (First) (Middle Initial)
Address: ______________________________________ City: _______________   State _______   Zip _______
Phone: (Wk)________________________ (Hm)_________________________   (Cell)______________________
SS #: _________________________    Email: _______________________________________________________

PAYMENT INFORMATION
(A copy of this form shall serve as receipt for payment)
Please check one of the following:

$425.00 - In Class Format (Includes Textbook & Materials)

Payment Plan (Credit Card or Money Order only). $225 payment with enrollment. Remaining $225 balance due on or before 2 weeks from the class start date.
$345.00 - Computer Based Independent Study (No Textbook) - Note: Payment and registration for computer course must be processed online.
$220.00 - In Class Format Retake Student (Includes Textbook & Materials)


Check #____________   Money Order ___________(No Cash Accepted)

 
MC or Visa (Circle One)# ________________________________________
Exp:_____/______ 3-Digit Security Code (Required): ________  
Authorized Signature: _____________________________________________   Date: _________________
Name of Registrar (Signature):___________________________________________

Refund Policy: No Refunds once a student has attended any in-class session. Metro Brokers Real Estate Academy retains a $30.00 administrative fee and a $65.00 book charge (if student received textbook in advance) for any refund paid prior to attending the first class of the course.   Student Initials: ____________

Notice: Metro Brokers Real Estate Academy reserves the right to cancel course prior to the first day of class. When course is canceled by Metro Brokers Real Estate Academy, students shall receive a 100% tuition refund or may elect to attend another scheduled pre-license course.

Textbook Received - Student Initials: _________________
 

 

Salesperson Prelicense Course Enrollment Application Continued
(Please select one or more of the following)

Please answer the following questions
1. Are you applying for a license as a Georgia resident? Yes ______ No ______
2. Are you a veteran with at least one year of active duty who served at least 90 days during wartime? Yes ______ No ______
3. Have you ever been licensed in another state as a broker or Salesperson?
If yes, where? __________ Under what last name? ____________ 		Yes ______ No ______
4. Have you ever held or do you hold a real estate license in GA?
If yes, please list license number__________________________ 		Yes ______ No ______
5. Are you a high school graduate or the holder of a (GED) General Education Development certificate? Yes ______ No ______
6. Have you ever been convicted of, pled nolocontendere to, or been granted first offender treatment upon being charged with: (1) any criminal offense other than a traffic violation or (2) any traffic violation that involved driving under the influence of alcohol or drugs, homicide or feticide by vehicle, fleeing the scene of an accident, attempting to elude a police officer or impersonation of a law enforcement official? * Yes ______ No ______
7. Have you ever been disciplined by the Georgia Real Estate Commission or any state or federal licensing agency or authority which regulates any profession? * Yes ______ No ______
8. Are there any criminal charges or licensing disciplinary proceedings pending against you at this time? Yes ______ No ______
9. Are you more than two (2) months behind in making child support payments? * Yes ______ No ______


* If you answered “Yes” to any of these questions (6, 7 or 9) you should immediately file an Application for Preliminary Decision with the Georgia Real Estate Commission. Application can be found by using this web address: http://www.grec.state.ga.us/PDFS/RealEstate/GRECbackgroundclearance.pdf

Source
Referred by Metro Brokers Agent? ______
Name: ____________________________________
Referred by former Prelicense Student? ______
Name: ____________________________________
Metrobrokers.com (website) ______
Atlanta Journal Constitution (AJC) ______
Billboard ______
TV commercial ______
Branch Office Sign ______
Monster.com ______
Mailer /Coupon ______
Other ______
Name: ____________________________________


Name of Student - Signature: ____________________________________________________________________