Application For Conversion From An Initial To A Standard Or Master Educator License (Page 2 of 3) in pdf

Application For Conversion From An Initial To A Standard Or Master Educator License Page 2

Statement of Fraud:

An application will be considered fraudulent, and may be denied, if it contains any false representation or omission of

material fact, or if false records are submitted in support of the application.

I certify under penalty of perjury and pursuant to the laws of the state of Iowa that the preceding information is true and

correct.

______________________________________________

_____________________________________________

Signature of Applicant

Date

SECTION II: To be completed by your Iowa public school Administrator.

Teacher has completed a mentoring and induction program, has 2 full years of teaching experience,

meets or exceeds all Iowa Teaching Standards, and is recommended for a Standard License.

(Superintendent’s signature NOT required.)

Teaching Experience

From (month) _______________ 20_____

Until (month) __________ 20_____

(Two years of public school experience are required to convert this license)

(If teaching experience is completed in more than one school district, each additional school district must

verify experience in that district. The district’s administrator should use official school letterhead to document the

dates of contracted teaching experience in that district.)

________________________________________ #_______________ ____________________

Evaluator’s Signature and Folder Number

Date

Teacher fails to meet the Iowa Teaching Standards. (Superintendent’s signature required ONLY if this

teacher is not recommended for licensure). It is the responsibility of the superintendent to report to the

Board of Educational Examiners the teacher’s failure to meet the Iowa Teaching Standards.

________________________________________ #_______________ ____________________

Evaluator’s Signature and Folder Number

Date

________________________________________ #_______________ District ______________________

Superintendent’s Signature and Folder Number (Not required if teacher is recommended for Standard License)

Application For Conversion From An Initial To A Standard Or Master Educator License Page 2