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After completing last field, save document to hard drive to make future updates or click Print button.   \n100 North First Street, E-240 Springfield, Illinois 62777-0001  \n73-86!  \nAPPLICATION FOR SHORT-TERM EMERGENCY APPROVAL IN SPECIAL EDUCATION FOR LEARNING BEHAVIOR SPECIALIST I  \nEDUCATOR EFFECTIVENESS DEPARTMENT  \nIMPORTANT: You also must apply online and pay the applicable fee through your Educator Licensure Information System (ELIS) account to be evaluated for this approval.  \nDIRECTIONS: The applicant should complete Section I and then send this form to the school district, special education cooperative, or entity that will be hiring so Section II can be completed. The completed form and the required documentation must be uploaded into ELIS by the ROE/ISC or emailed to us at [licensureforms@isbe.net](licensureforms@isbe.net) by the Chicago Public Schools Talent Office. Forms submitted by the educator will not be honored.  \n\n| SECTION I: APPLICANT INFORMATION |  |  |\n| --- | --- | --- |\n| NAME (Last, First, Middle, Maiden) | IEIN | BIRTHDATE (mm/dd/yyyy) |\n| ADDRESS (Street Number, City, State, ZIP Code) | EMAIL |  |\n|  | HOME TELEPHONE (Include Area Code) |  |\n\n\n| SECTION II: TO BE COMPLETED BY THE DISTRICT, SPECIAL EDUCATION COOPERATIVE, OR NONPUBLIC SPECIAL EDUCATION FACILITY |  |  |\n| --- | --- | --- |\n| REGION, COUNTY, DISTRICT, TYPE CODE/FACILITY CODE | DISTRICT NAME, COOPERATIVE OR JOINT AGREEMENT, EMPLOYING FACILITY |  |\n| ADDRESS (Street Number, City, State, ZIP Code) |  | TELEPHONE (Include Area Code) |\n\nAs administrator of this entity  \n1) I assure that supervision will be provided by the following individual who holds a Professional Educator License endorsed for special education supervision pursuant to Section 25.497.  \nEach supervisor must hold ONE of the following options:   \n• A General Administrative/Principal, Superintendent, or General Supervisory endorsement AND a Learning Behavior Specialist I (Prekindergarten through Age 21) endorsement  \n• A Director of Special Education endorsement  \n• A Learning Behavior Specialist I (Prekindergarten through Age 21) supervisory endorsement  \n\n| SUPERVISOR NAME (Last, First, Middle, Maiden) | IEIN | CREDENTIALS |\n| --- | --- | --- |\n\n2) I assure that we have exhausted all recruitment efforts and have been unable to secure the services of an individual who is appropriately licensed for the teaching position in question.  \nName Digital or Original Signature Title Date  \nSECTION III: TO BE COMPLETED BY THE REGIONAL SUPERINTENDENT OF EDUCATION (CPS Talent Office for Chicago applicants)  \nAs administrator of this entity:  \n• I have verified this form is completed in its entirety , and was submitted directly by the hiring district or special education cooperative.  \n• I have verified that the supervisor listed in Section II, Part 1, holds the required licensure and endorsements.  \nName Digital or Original Signature Title Date  \nISBE 73-86 (2/23)  \nSubmit via Email","cbCaieuligIKstlR","https://ap.wps.com/l/cbCaieuligIKstlR","pdf",323242,"English","# Section I: Applicant Information\n# Section II: To Be Completed by the District\n# Section III: To Be Completed by the Regional Superintendent of Education","[{\"question\":\"What are the steps for submitting this short-term emergency approval application?\",\"answer\":\"Complete Section I and send the form to the hiring district or special education cooperative so Section II can be completed. The completed form and documentation must be uploaded into ELIS by the ROE/ISC or emailed to the listed address; educator-submitted forms will not be honored.\"},{\"question\":\"What must the applicant do online in addition to submitting this form?\",\"answer\":\"Apply online and pay the applicable fee through the Educator Licensure Information System (ELIS) account to be evaluated for this approval.\"},{\"question\":\"What assurances must the district administrator provide in Section II regarding supervision?\",\"answer\":\"The administrator must assure supervision by an individual holding the required professional educator license endorsed for special education supervision, and the supervisor must meet one of the specified endorsement/credential options.\"}]","APPLICATION FOR SHORT-TERM EMERGENCY APPROVAL IN SPECIAL EDUCATION - LEARNING BEHAVIOR SPECIALIST I - ISBE 73-86 - Directions and Sections I-III | PDF",1791601321]