State Tax Commission Continuing Educational Course and Instructor Approval Request Reset Form

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Michigan Department of Treasury
4738 (Rev. 04-16)
State Tax Commission Continuing Educational Course and Instructor Approval
Request
The State Tax Commission is responsible for approving the education courses and instructors that assist assessors in fulfilling their continuing education
requirements for annual recertification. Approval of a continuing educational course may be requested of the State Tax Commission by completing this form
and providing all of the following required documentation:
a) Description of the course, including objectives.
b) Timed outline of the course, including the time expected to be spent on each covered subject.
c) Documentation of the qualifications of the Instructor(s), including programs previously instructed, resume, etc.
d) Signed Continuing Education Instructor Agreement (see page 2).
e) For online programs, include an explanation of the testing and accountability procedures.
f) Any additional relevant information that will assist in completing the review process.
Failure to submit a completed form and all of the required documentation may result in the request being returned without completion of a review. Approval
is granted for the renewal cycle (November 1 – October 31) in which the continuing education course is first held. Recertification must be requested and
approval obtained for each renewal cycle. Recertification of a course can be requested by completing and submitting State Tax Commission Continuing
Education Course Recertification Request (Form 5203).
Please allow two to four weeks for processing each request. To ensure pre-approval of a course, the completed form and required attachments must
be received by the State Tax Commission no less than 30 days prior to the scheduled event. The requestor will be notified upon completion of the
review. Approved courses will be listed on the Approved Assessor Continuing Education Course List located on the State Tax Commission’s website
(www.michigan.gov/statetaxcommission) under the Education and Certification heading.
Please submit the completed form and required documentation to the following address:
State Tax Commission
PO Box 30471
Lansing Michigan 48909
The form and documentation may also be e-mailed to Nancy Armstrong at [email protected]
EDUCATIONAL COURSE INFORMATION
Name of Course * (complete a separate form for each course)
Number of Course Hours (Min: 4)
Name of Organization or Individual Sponsoring the Course
Name of Instructor
Daytime Telephone Number
E-mail Address
Name of Co-Instructor (if applicable)
Daytime Telephone Number
E-mail Address
Will this course be offered on more than one occasion?
Dates the Course will be Offered During the Current Renewal Cycle (required)
Is this class presented exclusively online (see “E” above)?
Location of Course Offering
REQUESTOR CONTACT INFORMATION
Name of Requestor
Title or Position
Organization
Mailing Address of Requestor
Daytime Telephone Number
E-mail Address
*NOTE: In order for assessors to receive continuing education renewal credit, the course must be offered under the course name approved by the State
Tax Commission and be listed on the Approved Assessor Continuing Education Course List.
** Include the number of hours related to assessment administration in Michigan.
4738, Page 2
MICHIGAN STATE TAX COMMISSION
INSTRUCTOR AGREEMENT
Instructor Agreement Terms:
The State Tax Commission requires that instructors of the Michigan Certified Assessing Technician (MCAT), Michigan Certified
Assessing Officer (MCAO), Michigan Advanced Assessing Officer (MAAO), and Michigan Master Assessing Officer (MMAO)
Programs, and State Tax Commission sponsored Continuing Education Courses conduct themselves with integrity throughout their
teaching assignments.
An appropriate and professional relationship must be maintained with students both in and outside the classroom throughout the
teaching assignments.
It is the direction of the State Tax Commission that instructors strive to establish a positive learning environment within the classroom.
Harassment and/or discriminatory behavior within the classroom based on race, ethnicity, sex or physical disability is expressly
prohibited. Instructors are expected to actively discourage such behavior from occurring within the classroom and directly report such
behavior to the State Tax Commission.
Only State Tax Commission owned and approved material may be utilized in the classroom. Any additional material must be preapproved for use by the State Tax Commission in advance of the course offering.
As part of the preparation for an instructing assignment, instructors may have access to privileged information. To protect the integrity
of the education process, instructors are strictly prohibited from releasing information unless expressly allowed by the State Tax
Commission.
Upon completion of an education course that has been approved by the State Tax Commission for use in obtaining assessor
continuing education credit, the approved instructor will be granted assessor renewal credit hours for their preparation and instruction
of the course. The credit hours granted to the instructor will equal the number of hours that were approved by the State Tax
Commission for the course. Instructing the same course multiple times in the same renewal cycle will not result in the issuance of
accumulated assessor renewal credit hours to the instructor. For example, a course approved for four (4) hours that is taught four (4)
times, by the same instructor, in the same renewal cycle will result in four (4) hours of continuing education credit being issued not 16
hours.
Acknowledgement and Acceptance of Instructor Terms:
By signing below, I acknowledge the full right and authority to enter into this Instructor Agreement and accept and agree, within my
ability, to the terms and conditions as outlined within this Instructor Agreement. This Instructor Agreement is effective as of the date
below and remains in effect as long as I am an instructor for the State Tax Commission. I also acknowledge that I will be removed as
a State Tax Commission instructor and will be prohibited from providing further instruction for the State Tax Commission for the above
named programs and courses if I do not abide by the above stated terms.
Printed Name
Signature
December 2015
Date