California Escrow Association

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1 The has developed the attached documentation package in an effort to bring uniformity to the Escrow I, Escrow II and Escrow III courses presented by entities other than a university, college or community college to comply with the California Escrow Association s Education Achievement Award and professional designation requirements. Tel: (916) Fax: (916)

2 Class Presentation Schedule (916) Instructions: Type or print clearly. USE A SEPARATE SHEET OF PAPER FOR EACH CLASS PRESENTATION. To inform CEA of a new class, mark NEW box and provide all pertinent information below. To notify CEA of a change to a class schedule previously submitted, mark CHANGE, give the original date, time, and location and provide new information below. To cancel a class previously submitted, mark CANCEL and complete information below. This completed form must be received by CEA at least 14 days prior to the original class presentation. Subsequent presentations must be received at least 10 days prior to class presentation. Late submissions may not be accepted and attendees may not receive education credit. The information provided below must match the information on the Certificate of Completion and the provider roster. CHECK ONE: New Cancel Change Original /Time: Original Location: Provider ED #: Provider Name: _ Course ID#: Credit Hours: Instructor Name: Course Name: Start *: Start Time: End : End Time: *if course spans more than one day, each day must be listed in Daily Presentation Schedule chart below. Location of Presentation: (Please name) Street: Room/Suite: City: State: Zip: Daily Presentation Schedule: Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 (Attach sheet for additional days) : (month/day/year) Begin Time End Time I certify that the class information provided here is true and correct to the best of my knowledge. Any changes will be provided to CEA within seven (7) days of provider s knowledge of the change or within seven (7) days of completion of the class, whichever is earlier. Original Signature of Provider Director Printed Name of Provider Director Phone Number

3 Continuing Education Program Course Approval Application for Escrow I, Escrow II and Escrow III Instructions: (916) This form must be completed for each course to be approved. A completed application with the proper attachments and filing fee must be received by CEA at least 60 days prior to the first course presentation. All Courses must be a minimum of 18 hours, no fractional hours are granted. First Course Presentation : Provider Name: _ Address: Course Title: * Instruction Method: Seminar Workshop Other Classroom/lecture Webinar Number of continuing education course credit hours requested: For CEA use only: Course approved Course not approved By: Name: Title: *Advertising and course materials must use this exact title. Courses based on another provider s material must be approved by that provider and must use same name.

4 REQUIRED ATTACHMENT CHECKLIST: 1. A detailed outline of each topic is being presented, i.e.: class syllabus and final exam 2. A copy of all materials presented to each student must comply with minimum requirements as outlined in the Escrow I, Escrow II and Escrow III manuals approved by CEA. 3. Educational objectives for the course. CERTIFICATION: I certify under penalty of perjury that I have read and understand the information and requirements contained in this application, that all statements are true and nothing has been withheld which would influence a complete evaluation of this course. Original Signature of Provider Director Printed Name of Provider Director PLEASE SEND THIS COMPLETED APPLICATION ALONG WITH THE PROPER ATTACHMENTS AND FILING FEE TO: Filing Fees: Make check payable to: CEA Tel: (916) Fax: (916) Course applications must be received in this office at least 60 days prior to the first course presentation date. No education credit will be granted prior to the 60 th day from receipt of the completed application. Course advertisements for pending courses must clearly state that the course has been submitted and is pending approval, if the course application is complete and submitted within the appropriate time frame. INQUIRIES: (916)

5 Continuing Education Program Course Attendance Record and Verification Form (916) Course Title: Provider Name: Class Location: Street City State Class (s): _ VERIFICATION: I have reviewed and verified that the persons named on the attached Course Attendance Record Sheet(s), consisting of pages, were present at this class during the times and days indicated. Original Signature of Instructor Printed Name of Instructor CERTIFICATION: I have reviewed and verified this Course Attendance Record Verification and the attached Course Attendance Record Sheet(s), and certify that I find them accurate and in order, to the best of my knowledge. Original Signature of Provider Director Printed Name of Provider Director

6 Continuing Education Program Instructor Qualification Form (916) Instructions: This form must be completed by each proposed instructor, lecturer, moderator or person conducting a classroom course, seminar, workshop, conference, etc. Type or print clearly in ink. Provider Director must verify the information provided by the instructor. Attach additional sheets if more space is needed to answer questions. : Provider Name: _ Address: Telephone Number: Instructor Name: Mailing Address: Telephone Number: List the course titles to be taught: Describe your experience (3 years within the last 5 years) in the course subject matter:

7 Please indicate if you hold a recognized professional designation from the : Yes No If yes, check all that apply CEI CBSS CMHS CSEO CEO Other: Have you ever been the subject of any administrative agency disciplinary action? For the purpose of this question, administrative agency disciplinary action includes but is not limited to: having any professional, vocational or business license denied, suspended, placed on probation, restricted or revoked, or any fine imposed; withdrawing any application or surrendering any license to avoid disciplinary action; being issued a cease and desist order or its equivalent; being the subject of a conservation, liquidation, rehabilitation or receivership order. Yes No Have you ever been convicted of a crime? Yes No Crime includes a felony or misdemeanor and military offenses. Convicted includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a please of guilty or nolo contendere, having had any charge dismissed, expunged or plea withdrawn pursuant to Penal Code Section , or having been given probation, a suspended sentence or a fine. You may exclude traffic citations and juvenile offenses. IMPORTANT NOTE: If the answer is YES to either of the above two questions, attach a detailed statement, signed by you, listing the events which led to the charges (dates and places). If any disciplinary action was taken by an administrative agency, attach a certified copy of the action. INSTRUCTOR CERTIFICATION I certify under penalty of perjury that the information contained in this application is true and correct and that nothing has been withheld which would influence a complete evaluation of my qualifications and conduct as an instructor. Original Signature of Instructor PROVIDER VERIFICATION I certify under penalty of perjury that I have reviewed and verified the qualifications of the instructor named above. Original Signature of Provider Director Printed Name of Provider Director

8 CEA Industry: Provider, Course and Instructor Requirements Escrow I, Escrow II and Escrow III Provider Requirements 1) In order to apply for CEA Approved Education Provider Status, please Complete Form, Provider Certification Application and submit to the CEA Education Committee via CEA Headquarters. Application fee is $ payable to CEA. Approvals are good for two (2) years from the date of approval by the CEA Education Committee. 2) Providers are required to maintain, for a period of three (3) years, records of enrollments, completions, attendance, examination grades and instructor qualifications. These records shall be made available to CEA as requested. 3) Sign-in and sign-out sheets are required for each session. 4) Providers shall provide Certificates of Completion to those students successfully completing a course. Said Certificate of Completion to state hours attended and final grade. 5) Within 30 days following class completion, providers shall submit to CEA a provider Roster listing students given Certificates of Completion. 6) Course Applications can be submitted at the same time as Provider Applications. Course Requirements for Escrow I, Escrow II or Escrow III: 1) An approved provider must complete and submit Form, Course Approval Application, to CEA Education Committee for approval of each course to be offered. Application fees are $50.00 for each course. Approvals are good for two (2) years from date of approval. 2) Credit hours will be determined using a 50 minute contract hour. 3) Applications must include a detailed outline of the subject to be covered, examinations to be given, and scheduled times for starting and ending. 4) Applications must include the Instructor Qualification Form. 5) Applications must be received by CEA at least 60 days before course beginning date. 6) No student shall receive instruction for more than eight (8) hours per day. Instructor Requirements 1) Hold a professional designation from CEA of Certified Escrow Instructor. OR 2) Possess scholastic credentials, including, but not limited to, a current teaching credential from any state. Disclaimer No course approved shall be construed to be advertised or promoted as endorsed by the.

9 Continuing Education Program Provider Certification/Renewal Application (916) Check one only: Original filing Renewal Change of Provider Director Provider # 2. Entity Name: 3. Business Address: 4. Mailing Address: 5. Website: PROVIDER DIRECTOR: Individual within a provider organization with responsibility for the administration of the programs approved by CEA. 6 Provider Director Name: _ Last First Middle 7 Mailing Address: 8. Phone Numbers: Business Facsimile 9. address: 10. Is this organization now using or has it ever used any name other than #2 listed above? Yes No If YES, list such names and dates used: 11. The following information is required: a. Sample of attendance records form proposed for use meeting the requirement of CEA. b. Sample Certificate of Completion. 1 of 2

10 CERTIFICATION I agree to (a) maintain records of enrollments, attendance, exam grades and other pertinent information as requested by the for a period of three years (b) provide certificates of completion to those students who successfully complete courses (c) use only qualified instructors to conduct courses (d) timely provide CEA with completed course approval applications for programs submitted for credit approval, and (e) comply with CEA s continuing education regulations. Further, I certify under penalty of perjury that I am the person who has responsibility for the administration of the operations contained in this application; that the information contained in this application is true and correct; and that no approved course will be offered for credit unless the organization holds an active provider approval status. Lastly, I understand that I must promptly report to CEA any changes in the information contained in this form. Original Signature of Provider Director Print Name Filing Instructions: This form must be completed by each entity desiring to be certified or to renew certification as a continuing education provider. Type or print clearly in ink. All sections of this form must be completed and submitted with proper attachments and filing fees to CEA. Attach additional sheets if more space is needed to answer questions. Please send this completed application, other required attachments and a non-refundable $ filing fee to: Make checks payable to: Tel: (916) Fax: (916) of 2

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