NEBRASKA REAL ESTATE EXAMINATION 
BROKER RETAKE APPLICATION
RETAKE EXAMINATION FEE: $150.00
For Commission Use Only

____________________ Receipt#

FEES ARE NOT REFUNDABLE

INSTRUCTIONS:

  1. This application must be submitted to the Real Estate Commission office with the appropriate examination fee.
  2. NOTE:   If your original or updated application is more than one year old, a new original application, including a photo and full application fee, will be needed.
Name:

Last First Middle Soc. Sec. No.
Residence Address:

Street Number - Mailing Address City
County State Zip Telephone No.
(Date of Birth)
Email Address

I hereby make application to retake the Nebraska Real Estate Broker Examination. I have taken
the examination at a prior time and have been notified that I failed to receive a passing grade.


Submission of this Broker Retake Application verifies that all statements and information provided herein are true and correct and may be used as necessary by the Nebraska Real Estate Commission
if furtherance of assuring compliance with the laws it regulates.


Applicant's Name

Dated
Credit Card Information
Visa, Discover or MasterCard
Reminder - FEES ARE NOT REFUNDABLE
(Please note: Debit cards are not accepted)
Name:
Address 1:
Address 2:
City: State: Zip:
Card Number:
Expiration Date
(MM/YYYY):
Card CVV Number:
3 digit number on the back of the card:

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