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Florida Continuing Education Acknowledgement of
Personal Responsibility

Student's Name: Date:
License Number:
Exam Location:
Courses Taken:

To Be Signed by the Student
Each Student Must Achieve a Grade of 70% or Better on the Final Exam

I affirm that I personally completed the entire course study material. I also affirm that I completed the competency exam without any outside assistance from any person, directly or indirectly, while taking the exam.

Student’s Understanding: That a violation of such standards shall result in the loss of course credit and administrative sanction by the Florida Department of Financial Services based on paragraph 626.611(1)(g), F.S..

The examination may be taken without a proctor provided the student presents to the provider a sworn acknowledgement certifying that the student did not receive outside assistance from any person directly or indirectly, while taking the examination.
 

Student's Signature
(You can sign this form by typing in your name)		 Date

 

Before clicking Submit below
 
 Affidavit must be filled out completely for credit.
 Any missing information will delay credit to examinee.

If you are printing this affidavit to send to Broker Educational Sales & Training, Inc. then send to:
Broker Educational Sales & Training, Inc.
7137 Congress Street
New Port Richey, FL 34653
or fax to: 727-372-7585
or email to: processing@brokered.net

By pressing the Submit button below you are electronically sending this form to us.