Form DBPR CAM9 "Application for Pre-licensure Provider Approval" - Florida

What Is Form DBPR CAM9?

This is a legal form that was released by the Florida Department of Business & Professional Regulation - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2014;
  • The latest edition provided by the Florida Department of Business & Professional Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DBPR CAM9 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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Download Form DBPR CAM9 "Application for Pre-licensure Provider Approval" - Florida

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State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Pre-Licensure Provider Approval
Form # DBPR CAM 9
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Pay $250 application fee (make check payable to the Department of
Business and Professional Regulation).
 Submit instructor resumes showing qualifications and instructional
Pre-Licensure Provider
experience.
 Submit a sample certificate of completion for the course.
Approval
 Submit course outline/syllabus consistent with the education
requirements set forth in Rules 61E14-1.001(2) and 61E14-4.003(1)(b)
Florida Administrative Code.
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
GENERAL INFORMATION FOR PRE-LICENSURE EDUCATION PROVIDER APPROVAL
Record Keeping:
1. Course records and attendance rosters must be maintained by the provider for a minimum of four
(4) years per department rule.
2. Each course participant must also maintain his or her Certificate of Course Completion for three
(3) years from the date received.
3. Attendance records and course completion information for all course participants must be
provided to the Department in a specified format acceptable to the Department and within an
agreed upon timeframe. These records must be made available to the Department upon request.
Sales Presentations and Advertising:
1. No sales presentations may be conducted during, immediately before, or after the
administrations of any approved courses.
2. No course may be advertised or offered as an approved continuing education course unless
it has been approved pursuant to Rule 61E14-4.003, Florida Administrative Code.
3. Advertising for an approved course must include the provider approval number, course
approval number, number of contact hours, and course subject area as referenced in Rule
61E14-1.001(2), Florida Administrative Code.
Reapplication is required if substantive changes are made to the course.
Certificate of Course Completion:
1. Attach a copy of the Certificate of Course Completion that will be awarded to the course
participant upon completion of the course. Pre-licensure education requirements consist of
completing a minimum of 18 hours of instruction within 12 months prior to the date of passing the
examination.
2. Certificates of Course Completion are awarded upon the successful completion of an approved
continuing education course. Pursuant to Rule 61E14-4.003(2), Florida Administrative Code,
these certificates must contain the following information:
a. Course participant’s name
b. Course title
c. Course approval number
d. Date completed
e. Number of credit hours
f.
Statement to participant as required in Rule 61E14-4.003(2), Florida Administrative Code
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Pre-Licensure Provider Approval
Form # DBPR CAM 9
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Pay $250 application fee (make check payable to the Department of
Business and Professional Regulation).
 Submit instructor resumes showing qualifications and instructional
Pre-Licensure Provider
experience.
 Submit a sample certificate of completion for the course.
Approval
 Submit course outline/syllabus consistent with the education
requirements set forth in Rules 61E14-1.001(2) and 61E14-4.003(1)(b)
Florida Administrative Code.
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, FL 32399-0783
GENERAL INFORMATION FOR PRE-LICENSURE EDUCATION PROVIDER APPROVAL
Record Keeping:
1. Course records and attendance rosters must be maintained by the provider for a minimum of four
(4) years per department rule.
2. Each course participant must also maintain his or her Certificate of Course Completion for three
(3) years from the date received.
3. Attendance records and course completion information for all course participants must be
provided to the Department in a specified format acceptable to the Department and within an
agreed upon timeframe. These records must be made available to the Department upon request.
Sales Presentations and Advertising:
1. No sales presentations may be conducted during, immediately before, or after the
administrations of any approved courses.
2. No course may be advertised or offered as an approved continuing education course unless
it has been approved pursuant to Rule 61E14-4.003, Florida Administrative Code.
3. Advertising for an approved course must include the provider approval number, course
approval number, number of contact hours, and course subject area as referenced in Rule
61E14-1.001(2), Florida Administrative Code.
Reapplication is required if substantive changes are made to the course.
Certificate of Course Completion:
1. Attach a copy of the Certificate of Course Completion that will be awarded to the course
participant upon completion of the course. Pre-licensure education requirements consist of
completing a minimum of 18 hours of instruction within 12 months prior to the date of passing the
examination.
2. Certificates of Course Completion are awarded upon the successful completion of an approved
continuing education course. Pursuant to Rule 61E14-4.003(2), Florida Administrative Code,
these certificates must contain the following information:
a. Course participant’s name
b. Course title
c. Course approval number
d. Date completed
e. Number of credit hours
f.
Statement to participant as required in Rule 61E14-4.003(2), Florida Administrative Code
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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COURSE OUTLINE
In accordance with Rule 61E14-4.003(1)(b), Florida Administrative Code, a course outline which
describes the course’s content and subject matter should accompany the provider application. A course
outline should address the following:
Learner Objectives:
1. Objectives shall describe expected learner outcomes, how learner outcomes will be evaluated,
and describe how the objectives will be obtained.
2. The objectives shall describe the content, teaching methodology and plan for evaluation.
Subject Matter:
1. The content shall be specifically designed to meet the objectives and the stated level and learning
needs of community association managers. Specifically, it shall address one or more of the
subject areas outlined in subsection 61E14-1.001(2), Florida Administrative Code.
Materials and Methods:
1. Indicate how the course will be taught in order to achieve the learner objective. (Classroom,
distance/online or correspondence.)
2. Specify the time schedule for the course to ensure adequate time for the activities and level of
presentation.
3. Demonstrate that principles of adult education are utilized in determining teaching strategies and
learning activities.
4. List source material by name, date and format to ensure currency and applicability.
Course Evaluation:
1. Indicate how the course will be evaluated for meeting the learner’s needs (i.e. question and
answer session, class discussion, written examination).
2. Indicate how the course will be evaluated by the learner in relation to the course material,
learning experiences, instructional methods, facilities, and resources used.
COURSE INSTRUCTORS
Applicants must submit the resume of each instructor who will be presenting courses during the period of
providership. At a minimum the resume should include the instructor’s qualifications and instructional
experience consisting of at least:
1. A bachelor’s degree and two (2) years of experience in the subject matter being taught; or
2. An associate’s degree and four (4) years of experience in the subject matter being taught; or
3. Six (6) years of experience in the subject matter being taught.
Instructions
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation, Customer Contact Center, at 850.487.1395.
1) General Requirements
a) To maintain Provider status in good standing, providers must adhere to all provider
requirements outlined in
Rule 61E14-4.002, Florida Administrative
Code; and
Section
455.2178, Florida
Statutes.
b) Provider approval is valid until May 31
of odd numbered years and must be renewed.
st
2) Application Instructions (by section)
a) Section I- Application Type
b) Section II – Applicant Information
i.
Fill out each section completely.
ii.
In the “Applicant Information” section, applicants must use their name as it appears
on his or her social security card. Do not use any nicknames or initials.
iii. If applying as an Organization or Company, provide the name of the company or
organization that will provide educational services.
iv. A Social Security number is required in order to apply for any individual license within
the Department of Business and Professional Regulation.
v. If you are applying as an Organization or Company you must provide the Federal
Employer Identification Number (FEID) for the business.
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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vi. If the applicant provides other educational services for another board within the
Department of Business and Professional Regulation, please provide those provider
approval numbers.
vii. Provide your mailing address. This will be used for sending correspondence
regarding your application.
viii. Applicants must provide their business location address.
ix. Contact information is often used to quickly resolve questions with applications by
telephone call or email. If contact information is not provided, questions regarding
applications will be mailed to the applicant’s mailing address and may take longer to
resolve.
x. Additional contact information is optional and will be used when the applicant cannot
be reached using their primary contact information.
c) Section III- Affirmation by Written Declaration
i.
Each applicant must sign the affirmation by written declaration.
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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State of Florida
Department of Business and Professional Regulation
Regulatory Council of Community Association Managers
Application for Pre-Licensure Provider Approval
Form # DBPR CAM 9
If you have any questions or need assistance in completing this application, please contact the
Department of Business and Professional Regulation Customer Contact Center at 850.487.1395.
For additional information see the Instructions at the beginning of this application.
Section I – Application Type
APPLICATION TYPE
Pre-Licensure Provider- Organization [3803/1030]
Section II – Applicant Information
APPLICANT INFORMATION (Provider/Owner)
Last/Surname
First
Middle
Suffix
Company/Organization Name
Social Security Number (if applying as an Individual)*
Federal Employer ID Number (if applying as an Organization)
GENERAL IDENTIFICATION
Is Provider already approved by the Department of Business and Professional Regulation to provide
Yes No
continuing education?
If yes, what is/are the provider approval number?
MAILING ADDRESS
Company Name
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
BUSINESS LOCATION ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)
Street Address
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Last Name (Authorized Representative) First
Middle
Title
Suffix
Primary Phone Number
Primary E-Mail Address
* The disclosure of your Social Security number is mandatory on all professional and occupational license applications, is solicited
by the authority granted by 42 U.S.C. §§ 653 and 654, and will be used by the Department of Business and Professional Regulation
pursuant to §§ 409.2577, 409.2598, 455.203(9), and 559.79(3), Florida Statutes, for the efficient screening of applicants and
licensees by a Title IV-D child support agency to assure compliance with child support obligations. It is also required by § 559.79(1),
Florida Statutes, for determining eligibility for licensure and mandated by the authority granted by 42 U.S.C. § 405(c)(2)(C)(i), to be
used by the Department of Business and Professional Regulation to identify licensees for tax administration purposes.
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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Section III – Affirmation By Written Declaration
AFFIRMATION BY WRITTEN DECLARATION
I certify that I am empowered to execute this application as required by Section 559.79, Florida Statutes. I
understand that my signature on this written declaration has the same legal effect as an oath or
affirmation. Under penalties of perjury, I declare that I have read the foregoing application and the facts
stated in it are true. I understand that falsification of any material information on this application
may result in criminal penalty or administrative action, including a fine, suspension or revocation
of the license.
Signature:
Date:
Print Name:
DBPR CAM 9 Pre-Licensure Approval
2014 December
Incorporated by Rule 61- 35.020
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