Isbe Form 73 03C PDF Details

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.

QuestionAnswer
Form NameIsbe Form 73 03C
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesisbe form for correction information on certificate, 03c form, department of education illinois isbe form 73 03c, 73-03C

Form Preview Example

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

ILLINOIS STATE BOARD OF EDUCATION

!73-03C!

Educator Licensure Division

100 North First Street, S-306

Springield, 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 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)

 

 

 

 

 

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 certiicate 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 ile a tax return with the Illinois Department of Revenue, or failed to pay

 

 

 

 

any tax, penalty, or interest owed or any inal 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 inding 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 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

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 Certiicate

Endorsement area ____________________________________________________________

Supervisory endorsement

(One Endorsement per Application)

 

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 (K-12)

Provisional Vocational Occupational Field

_________________________________________________

(Vocational Subject to Be Taught)

Transitional Bilingual

_________________________________________________

Part-Time Provisional

(Language)

 

_________________________________________________

(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 Part-Time Provisional or a Provisional Vocational Certiicate. Applications for a Provisional Vocational Certiicate 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 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 above-named applicant has completed all requirements

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 73-03C (8/12)

Watch Isbe Form 73 03C Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .