Application For Conversion From An Initial To A Standard Or Master Educator License

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APPLICATION FOR CONVERSION
Board of Educational Examiners
Use Only
FROM AN INITIAL TO A STANDARD
OR MASTER EDUCATOR LICENSE
Mail to:
Board of Educational Examiners, Licensure
Grimes State Office Building
th
Revised 7/15
400 E. 14
St.
Des Moines, IA 50319-0147
I have included:
______ $86 licensure and background fees (payable to the Board of Educational Examiners – check or money order only)
_______ Application form including experience verification (do not apply before the required experience is fully completed)
_______ Master’s Degree transcripts
(Master Educator License ONLY – 5 years of experience and a Master’s Degree required)
LATE RENEWAL FEE. An additional fee of $25 per calendar month, not to exceed $150, shall be imposed if an application
is submitted after the expiration date. The board will waive the late fee for the following: (a) not currently practicing as an
educator in Iowa, (b) obtaining a Substitute License.
FYI – If you have taken any college credit or AEA licensure renewal credit before the issue date of the Standard
License, these hours cannot be used to renew the Standard License.
All fees are NONREFUNDABLE. Incomplete applications will be voided after 45 days. Please allow four weeks for
processing.
Applicant’s Folder #
Social Security #
Date of Birth
Male
Month
Day
Year
Female
Last Name
First Name
Middle Name
Maiden Name
Name changes require a photocopy of
official legal documentation.
Address
City
State
Zip Code
Evening Phone
Daytime Phone
Email Address
(
)
(
)
Background Information:
Attach a written explanation on 8 1/2" x 11" paper for any "Yes" response to questions “a” to “e.” Be sure to include the
date of the violation. DO NOT explain on this application form. If you have reported a "Yes" response on a previous
application, check “PR” (previously reported) instead of "Yes" on this application if no further conviction(s) has occurred.
a. Yes
No
PR
Have you ever been convicted of a felony?
b. Yes
No
PR
Have you ever been convicted of a crime other than parking or speeding violations?
(NOTE: Include all deferred judgments.)
c. Yes
No
Do you currently have any criminal charges pending against you?
d. Yes
No
PR
Have you ever had a founded report of abuse made against you?
e. Yes
No
PR
Have you ever had an educational license denied, revoked, or suspended?
f. Yes
No
Are you a United States citizen?
If you answered “No,” check if you are:
a qualified alien (as defined in 8 U.S.C.A. § 1641). If so, please provide appropriate documentation.
an alien who is paroled into the United States under 8 U.S.C.A. § 1182(d)(5) for less
than one year. If so, please provide appropriate documentation.
a foreign national not physically present in the United States.
other – Please provide a detailed explanation on a separate 8 ½ x 11 sheet of paper

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