Preparation and Evaluation
Forms
Appeal Forms • Health/Safety Forms • Higher Education • LPD Membership Form • NBTS • NCLB District Reports • Providers of Workshops, etc. • 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.
.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 |
NBPTS
| Form # | Form Name |
|---|---|
| 73-03E (11/11) |
Application for Master Certificate |
NCLB District Reports
- Local School District Equity Plan (3/11)
- Illinois Local School District Annual Report for Not–Highly Qualified Teachers (10/10)
- Roadmap for Each Not-Highly Qualified Teacher (3/11)
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 |
