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FSCP® Course Set-Up Application

Completed FSCP® Course Set-up Applications must be submitted 30 business days prior to the start date of class in order for students to be able to register and receive books in time for class.

All fields marked with an asterisk * are required.

Tell Us About Yourself

How many years of experience in financial services do you have?*

* Must have five years minimum

What type of class are you interested in moderating?*

Personal Information

Company Name*

Address to Send Moderator Kit

* No PO Boxes

Reserve Moderator Information

Reserve moderator is an optional back-up for the primary moderator. It is not required and no honorarium is paid to reserve moderators. Only one moderator can take the class free of charge.

Will there be a reserve moderator for your class?


Company Name

Resident License State

Insurance License Number

Class Sponsor

If Local Association Class is selected, please contact your Local Association to coordinate recruiting students and promoting NAIFA membership.

Closest Local Association

My Students

I have the following number of students ready to register for my class:

Number of Students

Class Details

Course I am Teaching

* Students must satisfy all other FSCP curriculum requirements prior to enrolling in FP 99.

Class Start Date

Day of Week Class will Meet

Time Class will Meet

Final Exam

* CE may be available for moderators who successfully complete the exam
** Must Have 5 students, not including the moderator, to be eligible to take the exam for free

I require CE credit and have verified that my license information is accurate
This confirms that I do not need CE credit reported for my current enrollment

Insurance License State

Insurance License Number

Moderator Agreement & Privacy Policies

In order to receive an honorarium, your class must have at least five students. Any live local moderator teaching a company exclusive class will not receive an honorarium. Please allow 60 days from the last class date for the processing of moderator payments. If teaching a live online class, you will log in to your live online classes 15 minutes in advance of the start time.

You are volunteering to assist an industry agency and any honorarium provided by The American College of Financial Services is to be the sole remuneration for your services in connection with this appointment. Your signature constitutes agreement that you will not accept compensation for these services from any other source, either directly or indirectly. It also evidences your agreement to abide by all rules and procedures adopted by The College and sponsoring association or agency regarding these courses and The College regarding the use of its educational materials.

While this agreement is in effect and for twelve months thereafter, following the latest course you have moderated, it is agreed that you will not place under contract any student enrolled during the effective period of this agreement, nor will you discuss company connection of any such student, whether or not the student is then under contract with any industry insurance company. You also agree that you will actively encourage your company associates to comply with the same limitations. You certify that you are engaged full-time as either a licensed agent, or supervisor, or financial training associate/agency, or head or home office employee and the information on the application is accurate. Also, you agree to perform all moderator duties required by The College, the associate or the agency, including the stipulations that you will personally moderate all class sessions, and will do so in the manner prescribed by The College; that you will maintain and promptly submit all class records required by The College; and that you will adhere to all rules and regulations established by The College for the conduct of sales training classes utilizing its educational materials and methods.

This agreement will be in effect for the duration of the course you are now moderating unless earlier terminated by the association or yourself with thirty days written notice. Submission of this form is your acceptance of the terms and conditions outlined in this Moderator Agreement. The American College of Financial Services respects the right to privacy of its students and is committed to safeguarding the personal information of each student. View the privacy policy here. Breaching the moderator agreement or privacy policy will result in your removal from the Sales Training Moderator program.

Privacy Policy

The American College of Financial Services respects the right to privacy of its students and is committed to safeguarding the personal information of each student. Please visit our website at to view our policy. Breaching the moderator agreement or privacy policy will result in being removed from the Sales Training Moderator program.

A completed W-9 Form is required before a moderator payment can be processed. Please send completed forms to



In order to teach classes in Georgia, moderators must be approved by the Georgia Department of Insurance. Approval is on a yearly basis. If you are not approved at the present time and would like to become approved as a moderator in the state of Georgia , please fax your autobiography, which should include three years of work experience and the GID-276-EN form to 610-526-1402 at least 60 days in advance of your anticipated start date. The College will submit your approval forms on your behalf.

Once completed, YOU MUST fax your information to 610-526-1402.
GID-276-EN Form