North Carolina State Board Of Education Legal Affairs Office printable pdf download

North Carolina State Board Of Education Legal Affairs Office

NORTH CAROLINA STATE BOARD OF EDUCATION

LEGAL AFFAIRS OFFICE

Teacher Misconduct Reporting Form

To report to the State Board of Education and the Superintendent of Public Instruction, the name and a

factual statement of any license holder who engages in professional misconduct, please complete and

submit the following information:

A. Please check if you are a:

______LEA #_______

______Charter School

Name of the school where the teacher was last employed: ________________________________

Grade Level and Subject(s) taught:___________________________________________________

Was this teacher also a coach? _____________________________________________________

Contact Person Name and Title ____________________________________________________

Telephone Number ( )________________________

Fax Number ( )______________________________

Email Address:_______________________________

B. Teacher Information:

Name (include all aliases)__________________________________________________________

____________________________________________________________

SSN xxx-xx-___________

Teacher’s Last Known Home Address:

______________________________________________________________________________

North Carolina State Board Of Education Legal Affairs Office