Isbe Form 73 03C PDF Details

Embarking on the journey to become a certified educator in Illinois involves navigating the intricacies of the application process, a crucial part of which is the completion of the ISBE 73 03C form. This document, integral for those aspiring to enter the educational field, serves as a bridge between academic preparation and professional recognition by the Illinois State Board of Education. It is meticulously designed to collect comprehensive information about the applicant, encompassing personal details, educational background, and a declaration of any past conduct that could influence their suitability for certification. Furthermore, the form plays an essential role in streamlining the application process for various types of teaching certificates, including but not limited to Initial Standard, Resident Teacher, Early Childhood, Elementary, Secondary, and Special K-12 Certificates. Applicants are guided to fill in their details, ranging from basic identification to more sensitive disclosures regarding criminal background or defaults on loans, with honesty and precision. The need for such detailed scrutiny underlines not only the importance of safeguarding the educational environment but also ensures that applicants meet the statutory requirements imposed by the state. Additionally, the process underscores the accountability measures in place, including the attestation regarding child support orders, thereby linking professional eligibility to personal responsibility. This form, while seemingly bureaucratic, encapsulates the state’s commitment to maintaining high standards in education through a rigorous vetting process, illustrating the balance between administrative procedures and the overarching goal of ensuring qualified, reliable, and responsible individuals stand at the forefront of Illinois classrooms.

QuestionAnswer
Form NameIsbe Form 73 03C
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshow to fill form73, 73-03C, isb 73 03c, isbe form 77 21a editable

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NOTE: City of Chicago residents should forward this form to the Educator Certification Division, Illinois State Board of Education, 100 North First Street, S-306, Springfield, Illinois 62777-0001.

ILLINOIS STATE BOARD OF EDUCATION

!73-03C!

Educator Licensure Division

100 North First Street, S-306

 

Springfield, Illinois 62777-0001

 

APPLICATION FOR TEACHING CERTIFICATE

Directions:: Please print or type the information requested, and sign in ink. Return this completed form to your Regional Office of Education, and include the applicable fee in the form of a cashier’s check. (Contact information is in your telephone book under local or county government, or at http://www.isbe.net/ regionaloffices/pdf/roedirectory.pdf.) Please contact your regional superintendent regarding to whom the cashier’s check should be made payable. Chicago residents should mail the application and applicable fee in the form of a cashier’s check, payable to the State Superintendent of Education, to the above address. Fees are not refundable or transferable.

PRINT NAME (Last, First, Middle, Maiden)

SOCIAL SECURITY NUMBER

BIRTHDATE (mm/dd/yyyy)

 

 

 

 

 

HOME ADDRESS (Street, City, State, Zip Code)

SEX

 

E-MAIL

 

 

Male

Female

 

 

 

 

 

 

 

TELEPHONE (Include Area Code) Home

TELEPHONE (Include Area Code) Work

 

 

 

 

 

(Attach written explanation for Yes answers.)

Yes

 

No

Have you ever had a certificate denied, suspended or revoked in Illinois or any other state?

 

Yes

 

No

Have you ever been convicted of a felony, or any sex, narcotics or drug offense in Illinois

 

Yes

 

No

or any other state?

 

 

Have you failed to file a tax return with the Illinois Department of Revenue, or failed to pay

 

 

 

 

any tax, penalty, or interest owed or any final assessment of same for any tax as required

 

 

 

 

 

 

by law and administered by that Department that was not subsequently resolved to the

 

 

 

Department’s satisfaction?

Yes

 

No

Have you ever been indicated as a perpetrator of child abuse or neglect by a state agency

 

 

 

 

responsible for child welfare? (Note: You must answer “Yes” to this question even if the

 

 

 

 

 

 

report was removed from the State Central register due to expiration of the retention period,

 

 

 

but you may answer “No” to this question if the finding was reversed on appeal.)

Yes

 

No

Are you in default on an Illinois student loan for which you have failed to establish a

 

 

 

 

satisfactory repayment plan with the Illinois Student Assistance Commission?

 

 

 

Signature Required

I certify, under penalty of perjury, that I do not have a child support order, and/or that I am not more than 30 days delinquent in complying with a child support order. I understand that I must sign this statement, whether or not I have children, and failure to so certify may result in disciplinary action, and making a false statement may subject me to contempt of court. A written explanation is

required for those unable to complete this certification.

_______________________________________

Original Signature of Applicant

_______________________________________

Date

If you previously held an Illinois certificate, complete the following:

Type __________________________ Number _______________________

NAME(S) OF COLLEGES AND UNIVERSITIES

STATE

DEGREE

DATE

ISBE CERTIFICATION OFFICE USE ONLY

DEGREE

CREDIT OR

TYPE

YEARS

EXP.

VALID

 

 

 

 

 

 

DATE CERTIFICATE ISSUED

CERTIFICATE NUMBER

THIS APPLICATION MAY BE USED TO REQUEST ONLY ONE CERTIFICATE

Initial

Standard

Resident Teacher

(Approved Programs Only)

 

 

Early Childhood

Elementary (K-9)

Secondary (6-12)

I am applying for a Special

K-12 Certificate

Endorsement area ____________________________________________________________

Supervisory endorsement

(One Endorsement per Application)

 

A special certificate may be issued as a single certificate or split to obtain an elementary and a secondary certificate. For information about the difference, go to www.isbe.net/certification/pdf/7303C_expl.pdf,

Substitute (K-12)

Provisional Vocational Occupational Field

_________________________________________________

(Vocational Subject to Be Taught)

Transitional Bilingual

_________________________________________________

Part-Time Provisional

(Language)

 

_________________________________________________

(Subject Taught)

I do hereby affirm that the information provided above and the credentials, including transcripts and other supporting documents, are true, correct and complete.

NOTE: Applicants who knowingly alter or misrepresent their qualifications in order to obtain a certificate shall be denied its issuance and may be subject to the suspension or revocation of all previously held certificates..

_____________________________________________

________________________

_____________________________________________

________________________

Original Signature of Applicant

Date

Original Signature of Requesting Illinois Regional Superintendent

Date

Signature of District Superintendent is required if application is being made for a Part-Time Provisional or a Provisional Vocational Certificate. Applications for a Provisional Vocational Certificate also require ISBE Form 73-23.

__________________________________

___________________________________________________

___________________________________________________

Telephone (Include Area Code)

District Name and Number

Original Signature of Hiring District Superintendent or Board Secretary

This section must be completed by Illinois Teacher Education Institution if certificate is to be issued by entitlement. Ignore this section of the form if certification by evaluation (individual applies directly) is requested.

As the authorized official of this recognized Illinois teacher education institution, I

do hereby certify that the above-named applicant has completed all requirements

of the certification statutes and relevant rules and regulations and has successfully completed an approved program leading to the certification and endorsement for which the applicant is recommended.

_____________________________________________________________________

Institution Submitting Application

________________________________________________

___________________

Original Signature of Authorized Official and Seal of Institution

Date

ISBE 73-03C (8/12)

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step 1 to writing isbe forms

Note the demanded details in the box w h c a t t, Have you ever been indicated as a, Yes No, Are you in default on an Illinois, Original Signature of Applicant, Date, If you previously held an Illinois, ISBE CERTIFICATION OFFICE USE ONLY, NAMES OF COLLEGES AND UNIVERSITIES, STATE, DEGREE, DATE, DEGREE, CREDIT OR EXP, and TYPE.

part 2 to finishing isbe forms

Remember to identify the significant information from the Subject Taught I do hereby affirm, revocation of all previously held, Original Signature of Applicant, Original Signature of Requesting, Signature of District, Telephone Include Area Code, District Name and Number, Original Signature of Hiring, This section must be completed by, ISBE C, Institution Submitting Application, and Original Signature of Authorized segment.

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