Isbe Form 73 03C ≡ Fill Out Printable PDF Forms Online

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.

Question	Answer
Form Name	Isbe Form 73 03C
Form Length	1 pages
Fillable?	Yes
Fillable fields	60
Avg. time to fill out	12 min 19 sec
Other names	S-306, isbe form for correction information on certificate, isbe, illinois 73 form

12

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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	!73-03C!
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

<![endif]>(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
Yes		No	Have you ever been convicted of a felony, or any sex, narcotics or drug offense in Illinois
Yes		No
Yes		No	or any other state?
			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
Yes		No
			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
Yes		No
			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
	DEGREE	EXP.	TYPE	VALID
		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 73-03C

Note the demanded details in the box an, a, px, ene sr, ews, na, seY ttir, wh, ca Yes, No Yes, No Original, Signature, of, Applicant Date, IS, BE, CERTIFICATION, OFFICE, USE, ONLY NAMES, OF, COLLEGES, AND, UNIVERSITIES STATE, DEGREE, DATE, DEGREE, and CREDITOR.

part 2 to finishing 73-03C

Remember to identify the significant information from the Part, Time, Provisional One, Endorsement, per, Application Language, Telephone, Include, Area, Code IS, BEC and Institution, Submitting, Application segment.

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