The Frederick Academy of Real Estate

THE FREDERICK ACADEMY OF REAL ESTATE

"Professionals Serving Professionals"

www.frederickacademy.net

Colin F. McGowan, President/Director

11849 Ramsburg Road 530 Sterling Drive

Marriottsville, Maryland 21104 Red Lion, Pennsylvania 17356

800-854-0950 Telephone 800-339-6089 Telephone

410-442-1395 Fax 717-244-6824 Fax

Notice To All Students:

You must submit this form to the Frederick Academy of Real Estate - Maryland when you complete your lessons. It is required to receive your Certificate of Completion.

You can fax this form to The Frederick Academy of Real Estate at 717-244-6824 or you may return it by mail to:

The Frederick Academy of Real Estate

530 Sterling Drive

Red Lion, Pennsylvania 17356

STUDENT AFFIDAVIT

“I certify that I have personally completed each assigned lesson module of instruction.”

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Student’s Signature Date

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Print Name License Number

List Course(s):

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Approved to offer courses in Maryland, Pennsylvania, Florida, Virginia, Ohio

West Virginia, Delaware, New Hampshire, the District of Columbia and New York