Isbe Form 73 03C is a required form for all Illinois school districts. The form is used to report the district's financial status and budget. This guide will provide an overview of the contents of the form, and instructions on how to complete it. Completing this form accurately is essential for ensuring that your district stays in compliance with state regulations.
Here, you will find a number of details about isbe form 73 03c PDF. It's a good idea that you read through this information before you start working with the form.
| Question | Answer |
|---|---|
| Form Name | Isbe Form 73 03C |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | isbe form for correction information on certificate, 03c form, department of education illinois isbe form 73 03c, 73-03C |
NOTE: City of Chicago residents should forward this form to the Educator Certiication Division, Illinois State Board of Education, 100 North First Street,
ILLINOIS STATE BOARD OF EDUCATION |
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Educator Licensure Division |
100 North First Street,
Springield, Illinois
APPLICATION FOR TEACHING CERTIFICATE
Directions:: Please print or type the information requested, and sign in ink. Return this completed form to your Regional Ofice 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/ regionalofices/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) |
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HOME ADDRESS (Street, City, State, Zip Code) |
SEX |
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Male |
Female |
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TELEPHONE (Include Area Code) Home |
TELEPHONE (Include Area Code) Work |
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(Attach written explanation for Yes answers.)
Yes |
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No |
Have you ever had a certiicate denied, suspended or revoked in Illinois or any other state? |
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Yes |
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No |
Have you ever been convicted of a felony, or any sex, narcotics or drug offense in Illinois |
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Yes |
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No |
or any other state? |
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Have you failed to ile a tax return with the Illinois Department of Revenue, or failed to pay |
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any tax, penalty, or interest owed or any inal assessment of same for any tax as required |
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by law and administered by that Department that was not subsequently resolved to the |
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Department’s satisfaction? |
Yes |
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No |
Have you ever been indicated as a perpetrator of child abuse or neglect by a state agency |
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responsible for child welfare? (Note: You must answer “Yes” to this question even if the |
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report was removed from the State Central register due to expiration of the retention period, |
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but you may answer “No” to this question if the inding was reversed on appeal.) |
Yes |
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No |
Are you in default on an Illinois student loan for which you have failed to establish a |
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satisfactory repayment plan with the Illinois Student Assistance Commission? |
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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 certiication.
_______________________________________
Original Signature of Applicant
_______________________________________
Date
If you previously held an Illinois certiicate, complete the following:
Type __________________________ Number _______________________
NAME(S) OF COLLEGES AND UNIVERSITIES |
STATE |
DEGREE |
DATE |
ISBE CERTIFICATION OFFICE USE ONLY
DEGREE |
CREDIT OR |
TYPE |
YEARS |
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EXP. |
VALID |
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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
Secondary
I am applying for a Special
Endorsement area ____________________________________________________________
Supervisory endorsement |
(One Endorsement per Application) |
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A special certiicate may be issued as a single certiicate or split to obtain an elementary and a secondary certiicate. For information about the difference, go to www.isbe.net/certiication/pdf/7303C_expl.pdf,
Substitute
Provisional Vocational Occupational Field
_________________________________________________
(Vocational Subject to Be Taught)
Transitional Bilingual
_________________________________________________
(Language) |
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(Subject Taught)
I do hereby afirm 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 qualiications in order to obtain a certiicate shall be denied its issuance and may be subject to the suspension or revocation of all previously held certiicates..
_____________________________________________ |
________________________ |
_____________________________________________ |
________________________ |
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
__________________________________ |
___________________________________________________ |
___________________________________________________ |
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 certiicate is to be issued by entitlement. Ignore this section of the form if certiication by evaluation (individual applies directly) is requested.
As the authorized oficial of this recognized Illinois teacher education institution, I
do hereby certify that the
of the certiication statutes and relevant rules and regulations and has successfully completed an approved program leading to the certiication and endorsement for which the applicant is recommended.
_____________________________________________________________________
Institution Submitting Application
________________________________________________ |
___________________ |
Original Signature of Authorized Oficial and Seal of Institution |
Date |
ISBE