Educator Certification
Forms
Applications for Certificates • Appeal Forms • Higher Education • NBTS • NCLB District Reports • Providers of Workshops, etc. • Registration/Updates • Requests for Approval • Statement of Assurance
Below you will find the online version of the forms from our office. Each form is saved in the PDF format. Please take the printed form and submit to your local Regional Office of Education.
Note: The following documents are in 
.pdf format and may contain form fields. In order for them to work correctly please visit http://www.adobe.com to download version 9.0 of Adobe Reader.
.pdf format and may contain form fields. In order for them to work correctly please visit http://www.adobe.com to download version 9.0 of Adobe Reader.
Requests
for Priority Review of Certification Applications
Instruction
Sheet for filling out a Form ONLINE
Applications for Certificates
| Form # | Form Name |
|---|---|
| 73-01 (3/04) |
Application for Alternative Certificate |
| 73-03C (4/09) |
Teaching Certificates: Early Childhood,
Elementary, Secondary, Special, Substitute, Provisional
Vocational, Transitional Bilingual, Resident Teacher,
Part-time Provisional Option to split a special certificate to elementary and secondary certificates |
| 73-03D (8/05) |
School Service Personnel or Administrative |
| 73-03E (5/09) |
Application for Master Certificate |
| 73-03F (9/07) |
Visiting International Teacher Certificate |
| 73-05 (09/07) |
State-Approved Program Verification |
| 73-23 (9/00) |
Provisional Vocational Certificate |
| 73-52 (1/09) |
Endorsement of Elementary, Secondary or Administrative Certificate |
| 73-52A (Updated 11/09) |
Application for Teacher Leader Endorsement of Issued Certificate |
| 73-63 (Updated 9/09) |
Request for Issuance of Provisional Certificate |
| 73-86 (5/09) |
Short-term Emergency in Special Education |
| 73-91 (8/03) |
Notice of Intent to Become a United States Citizen |
| 73-91A | Foreign Credentialing for Substitute and/or Para-Professional Certificate |
| 73-93 (1/04) |
Application for One-Year Reinstatement |
| 73-94 (8/09) |
Interim Certification as School Counselor Intern |
| 73-99 (9/07) |
Confirmation of State Certification Tests
Taken Not to be used by those applying after August 25, 2009. |
Appeal
Forms
| Form # | Form Name |
|---|---|
| 77-17 (9/08) |
Appeal to RPDRC of LPDC's Recommendation for Nonrenewal of a Standard/Master Certificate or Regional Superintendent's Recommendation for Non-issuance of a Standard Certificate |
| 77-18 (9/08) |
Appeal to State Teacher Certification Board |
Higher
Education
| Form # | Form Name |
|---|---|
| 77-39 (3/08) |
Teacher Leader Endorsement Strand Approval
Form Instructions to complete the form |
National
Board for Professional Teaching Standards
| Form # | Form Name |
|---|---|
| 77-23 (12/08) |
Verification of Eligibility for Master Certificate Stipend |
| 77-25A (12/08) |
2008–2009 Statement of Intent to Provide Mentoring/Professional Development |
| 77-26 | Documentation of 2008-2009 Assistance/Mentoring to NBPTS Candidates |
| 77-27 | Documentation of 2008-2009 Professional Development and/or Mentoring for New or Experienced Teachers |
| 77-28 | Documentation of 2008-2009 Professional
Development and/or Mentoring to Teachers in Schools
on AEW Status or Schools Where 50% or more of Students
receive Free and Reduced-Price Lunches |
| 77-32 (3/09) |
Illinois National Board Candidate Fee Subsidy Application |
NCLB District Reports
- District HQ Report Instructions
- Local School District Equity Plan (Updated 4/08)
- Illinois Local School District Annual Report for Not–Highly Qualified Teachers (Updated 9/08)
- Roadmap for Each Not-Highly Qualified Teacher
Providers
of Workshops, Conferences, Seminars, etc.
Registration/Updates
of Certificates
| Form # | Form Name |
|---|---|
| 73-10 (9/07) |
Certificate Registration Form |
| 77-08 (9/00) |
Notification of Change in Teaching Circumstances (Exemptions) |
| 73-71 (10/08) |
Certification Update/Duplicate Certificate Request/Name or address change |
| 73-83 (9/09) |
Verification of Teaching Experience for Removal of Limitations on Limited Learning Behavior Specialist I (LBS I) Endorsement |
| 73-85 (3/04) |
Request for Review of File to Remove Limitations on LBS I |
| 73-92 (12/03) |
Certificate of Completion for LBS I Training Sequence |
Requests
for Approval
| Form # | Form Name |
|---|---|
| 73-26 (6/08) |
Request for Evaluation of Approval Areas of Special Education |
| 73-42 (6/08) |
Approval of Other Special Education Personnel |
| 73-44 (3/04) |
Notification of School Service Personnel Intern Eligibility Status |
| 73-49 (Updated 11/09) |
Approval as a Bilingual or ESL Teacher |
| 73-51 (12/08) |
Request for Approval of a Speech and Language Paraprofessional |
| 73-53 (10/07) |
Educational Interpreter Log |
| 73-67 (Updated 11/09) |
Bilingual Special Education Approval |
| 73-72 (4/08) |
Nonpublic School Request for Approval of Other Special Education Personnel |
| 73-95 (1/09) |
Paraprofessional Approval/Approval for Paraprofessional Employment in Title I Positions |
| 73-96 (5/09) |
Request for Authorization to Employ Teacher in Position Otherwise Unfilled |
| 77-35 (12/05) |
Request for Approval as an Educational Interpreter |
| 77-36 (8/06) |
Request to Report Status of Bilingual Teacher, Special Education, and Rural School Teacher as Highly Qualified for NCLB Purposes |
Statement of Assurance
The following are downloadable paper forms. To submit Assurance
Statements online, use ECS| Form # | Form Name |
|---|---|
| 73-97 (8/08) |
Assurance Statement for Initial to Standard-Level Teaching Certification |
| 73-98 (9/08) |
Assurance of Completion of Professional Development for Renewal of Standard/Master Certificates |
| 77-34 (8/08) |
Assurance of Local Assessment for Paraprofessionals |
Membership of Local Professional Development Committees (77-12)
