Educator and School Development

Forms

Appeal Forms • Health/Safety Forms • Higher Education • LPD Membership Form • NBTS • NCLB District Reports • Providers of Workshops, etc. • Registration/Updates • 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 the latest version of Adobe Reader.

Instruction Sheet for filling out a Form ONLINE

Appeal Forms

Form #	Form Name
77-17 (1/10)	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 (1/10)	Appeal to State Teacher Certification Board

Health/Safety

Form #	Form Name
33-99 (3/11)	Building and Fire Safety Review Form

Higher Education

Form #	Form Name
77-39 (1/10)	Teacher Leader Endorsement Strand Approval Form Instructions to complete the form

NBPTS

Form #	Form Name
73-03E (11/11)	Application for Master Certificate

NCLB District Reports

Providers of Workshops, Conferences, Seminars, etc.

Form #	Form Name
77-21A (9/08)	Evaluation Form
77-21B (9/09)	Evidence of Completion Form

Registration/Updates of Certificates

Form #	Form Name
77-08 (1/10)	Notification of Change in Teaching Circumstances (Exemptions)
77-36 (1/10)	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 (1/10)	Assurance Statement for Initial to Standard-Level Teaching Certification
73-98 (1/10)	Assurance of Completion of Professional Development for Renewal of Standard/Master Certificates