Form DBPR HI0404 "Education Course Application" - Florida

What Is Form DBPR HI0404?

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 March 1, 2013;
  • 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 HI0404 by clicking the link below or browse more documents and templates provided by the Florida Department of Business & Professional Regulation.

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State of Florida
Department of Business and Professional Regulation
Home Inspectors
Education Course Application
Form # DBPR HI 0404
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Complete all sections of this application.
 No fee is required.
 A detailed course outline describing the course’s content and subject
matter, and a written statement that explains in detail how the course
relates to the practice of home inspection.
Continuing
 Sample certificate of course completion.
Education/Pre-
 Submit a course syllabus.
licensure Course Initial
 List the instructors for each course and license number of each home
or Renewal
inspector.
If the course is interactive submit documents requested in Section III.
 Record Keeping: Attendance records must be maintained for a
minimum of 4 years. 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.
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Florida 32299-0780
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 for Home Inspection Continuing Education Course Application
a. All portions of the application must be completed.
b. Continuing education providers must submit a sample course completion certificate with the
application. The sample course completion certificate must include the provider’s name, the
provider’s approval number, the licensee’s name, the licensee’s license number, the
approved course title, the course approval number, the course completion date, and the
number of approved continuing education credit hours awarded in each subject area covered
by the course.
c. Continuing education course applications must include course detail. Course detail includes:
i.
Course Outline: Attach a course outline specifying subjects, major topics, and subtopics
to be covered in the course. Each subject must also include a narrative summary.
Reference and Source Materials: Include a list of all reference and source materials,
ii.
along with their publication date(s), for the course.
iii.
Course Evaluation: Attach a copy of the evaluation forms used to assess the learning
experience, instructional methods, and course materials.
iv.
Instructors: List the instructors for each course, and attach a resume for each instructor
even if previously approved for another course. Instructors must possess sufficient skills
and knowledge in the subject areas being taught.
Record Keeping: Attendance records must be maintained for a minimum of four years.
v.
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.
DBPR HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503
1 of 5
State of Florida
Department of Business and Professional Regulation
Home Inspectors
Education Course Application
Form # DBPR HI 0404
APPLICATION CHECKLIST – IMPORTANT – Submit all items on the checklist below with your
application to ensure faster processing.
APPLICATION
APPLICATION REQUIREMENTS
 Complete all sections of this application.
 No fee is required.
 A detailed course outline describing the course’s content and subject
matter, and a written statement that explains in detail how the course
relates to the practice of home inspection.
Continuing
 Sample certificate of course completion.
Education/Pre-
 Submit a course syllabus.
licensure Course Initial
 List the instructors for each course and license number of each home
or Renewal
inspector.
If the course is interactive submit documents requested in Section III.
 Record Keeping: Attendance records must be maintained for a
minimum of 4 years. 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.
Please mail your completed application, documentation to:
Department of Business and Professional Regulation
2601 Blair Stone Road
Tallahassee, Florida 32299-0780
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 for Home Inspection Continuing Education Course Application
a. All portions of the application must be completed.
b. Continuing education providers must submit a sample course completion certificate with the
application. The sample course completion certificate must include the provider’s name, the
provider’s approval number, the licensee’s name, the licensee’s license number, the
approved course title, the course approval number, the course completion date, and the
number of approved continuing education credit hours awarded in each subject area covered
by the course.
c. Continuing education course applications must include course detail. Course detail includes:
i.
Course Outline: Attach a course outline specifying subjects, major topics, and subtopics
to be covered in the course. Each subject must also include a narrative summary.
Reference and Source Materials: Include a list of all reference and source materials,
ii.
along with their publication date(s), for the course.
iii.
Course Evaluation: Attach a copy of the evaluation forms used to assess the learning
experience, instructional methods, and course materials.
iv.
Instructors: List the instructors for each course, and attach a resume for each instructor
even if previously approved for another course. Instructors must possess sufficient skills
and knowledge in the subject areas being taught.
Record Keeping: Attendance records must be maintained for a minimum of four years.
v.
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.
DBPR HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503
2 of 5
d. Fee: No fees.
2. Application Instructions (by section)
a. Section I
i.
Check only one of the application types.
ii.
Home Inspector Pre-licensure Course Initial: Select this application type if you are
applying for an initial approval of a pre-licensure education course.
iii.
Home Inspector Pre-licensure Course Renewal: Select this application type if you are
applying for renewal of a pre-licensure education course. If there have been any changes
to the course, other than the instructors, you must select “Home Inspector Pre-licensure
Course Approval” as the application type and submit the supporting documentation
required of an initial course approval.
iv.
Home Inspector Continuing Education Course Initial: Select this application type if you
are applying for an initial approval of a continuing education course
v.
Home Inspector Continuing Education Course Renewal: Select this application type if
you are applying for the renewal of a continuing education course. If there have been
any changes to the course, other than the instructors, you must select “Continuing
Education Course Approval” as the application type and submit the supporting
documentation required of an initial course approval.
b. Sections II
i.
Fill out each section completely.
ii.
Each applicant must provide their name, company or organization name, and their
provider approval number.
iii.
Applicants seeking to renew a course approval must also provide their current course
approval number.
c. Section III
i.
Applicants must provide the course title. The title you choose must adequately define the
content of the course. If you are applying to approve more than one course, please
complete additional applications as necessary.
ii.
Indicate which subject areas will be covered in the continuing education course and the
number of credit hours assigned to each subject area.
iii.
Indicate how the course will be provided to the student by checking the appropriate box.
d. Section IV
i.
Please indicate if this course has been previously approved. If it has been approved,
indicate by which Board.
e. Section V
i.
Please read and sign the affirmation by written declaration.
ii.
If the applicant fails to sign the affirmation statement, the Department will not process the
application.
3. Other Information
a. Continuing education course providers shall not advertise a course as approved for
continuing education credit from the Department of Business and Professional Regulation
until the course has been approved by the Department and a course number has been
assigned.
b. Providers should supply all students with a course completion certificate upon completion of
the course.
c. Approved course numbers and course titles should be used in all advertisements.
d. Any substantive changes regarding the provider’s application information must be filed with
the Department within thirty days of the change.
e. Provider approval is valid until May 31 of odd-numbered years and must be renewed.
Providers are responsible for renewing all courses prior to the course expiration date.
f.
Providers must work with licensees to resolve reporting conflicts.
g. Course approval is valid for two years from the date of board approval. Providers must
reapply for course renewal every two years.
Refer to Rule 61-30.502 and 61-30.503, Florida Administrative Code, for additional information
regarding provider and course requirements.
DBPR HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503
3 of 5
State of Florida
Department of Business and Professional Regulation
Home Inspectors
Application for Continuing Education Course Approval or Renewal
Form # DBPR HI 0404
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 (choose only one application type)
CHECK ONE OF THE APPLICATION TYPES
Approval of Home Inspector Pre-licensure Course - Initial [0403/1020]
Approval of Home Inspector Pre-licensure Course - Renewal [0403/2020]
Approval of Home Inspector Continuing Education Course - Initial [0405/1030]
Approval of Home Inspector Continuing Education Course - Renewal [0405/2020]
Section II – Applicant Information- Provider
PROVIDER INFORMATION
Last/Surname (Provider)
First
Middle
Suffix
Company/Organization Name
Provider Approval Number
Course Approval # (If renewal)
MAILING ADDRESS
Street Address or P.O. Box
City
State
Zip Code (+4 optional)
County (if Florida address)
Country
CONTACT INFORMATION
Contact Name:
Primary Phone Number
Primary E-Mail Address
BUSINESS LOCATION ADDRESS
Street Address
City
State
Zip Code
County (if Florida address)
Country
ADDITIONAL CONTACT INFORMATION (OPTIONAL)
Alternate Phone Number
Fax Number
Alternate E-Mail Address
DBPR HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503
4 of 5
Section III – Course Information
COURSE INFORMATION
Course Title:
Total Number of Hours:
Course Delivery Method:
Classroom
Interactive Distance Learning
COURSE INSTRUCTORS
Last/Surname
First
Middle
Suffix
(1)
Last/Surname
First
Middle
Suffix
(2)
Last/Surname
First
Middle
Suffix
(3)
INTERACTIVE DISTANCE COURSES
Interactive Distance courses must submit documents indicating the following:
1. The means by which the course will demonstrate interactivity between the student and course provider within
a maximum of 24 hours, which promotes student involvement, and demonstrates that the course measures
learning and addresses comprehension of content at regular intervals.
2. The means by which the course provider is able to monitor student enrollment, participation and course
completion.
3. The means by which the course provider will be able to satisfactorily demonstrate that stated course hours are
consistent with the actual hours spent by each student to complete the course.
4. The means by which the provider will assure qualified instructor(s) will be available to answer questions and
provide students with necessary support during the course.
5. That the student will be required to complete a statement at the beginning and end of the course that indicates
that he/she personally completed each module/session of instruction.
6. The means by which the course provider will verify student identification.
Section IV – Course Component Information
COMPONENT INFORMATION
Pre-Licensure Education
Continuing Education
Must address home inspection services or the
Must address one or more of the following eight
components of a home, including the limited
topics: the structure, electrical system, HVAC
visual examination of the readily accessible
system, roof covering, plumbing system, interior
installed systems and components of a home
components, exterior components and/or site
for the purposes of providing a written report of
conditions that affect the structure.
the condition of the home, for a total of 120
hours.
Section V – Approval by Other Boards
PRIOR BOARD APPROVAL
Has this course been previously approved by another board as listed in Rule 61-30.503, F.A.C.?
 Yes  No
If “yes” please complete the following:
Name of Board
Date of Approval
Name of Board
Date of Approval
Name of Board
Date of Approval
DBPR HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503
5 of 5
Section VI– 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 HI 0404 Application for Education Course Approval/Renewal
Eff. Date March 2013
Incorporated by Rule: 61-30.503