STATE-APPROVED PROGRAM VERIFICATION FOR GIFTED EDUCATION SPECIALIST ONLY - PART I - TO BE COMPLETED BY APPLICANT

Oct 10, 2026

State-approved program verification form for applicants seeking an Illinois license as a Gifted Education Specialist. Part I is completed by the applicant after finishing a state-approved preparation program at a college or university. The applicant provides personal identification, contact details, and college/university information, and directs the institution to email the completed form to licensureforms@isbe.net. Submitted or returned forms by the applicant or the Regional Office of Education are not honored. Part II requires the college/university to confirm program completion, including clinical experiences and coaching/mentoring requirements.

LanguageEnglish

CategoryExam

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Part I - To be completed by applicant

Applicant information

Part II - To be completed only by the college/university

Program completion verification

Clinical experiences and mentoring requirements

Certification and signature

Use your "Mouse" or "Tab" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click Print button. 100 North First Street, E-240 Springfield, Illinois 62777-0001 !73-05G STATE-APPROVED PROGRAM VERIFICATION FOR GIFTED EDUCATION SPECIALIST ONLY EDUCATOR EFFECTIVENESS DEPARTMENT PART I - TO BE COMPLETED BY APPLICANT An applicant applying for an Illinois license who has completed a state-approved program of preparation at a college or university shall use this form to verify completion of the program. The applicant should provide all information requested in Part I of this form. Please request that [the college/university email the completed form to](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[ ](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[licensureforms@isbe.net](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[. Forms](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[ submitted by](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[ the applicant or Regional](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)[ ](the college/university email the completed form to licensureforms@isbe.net. Forms submitted by the applicant or Regional)Office of Education will not be honored. | APPLICANT'S NAME (Last, First, Middle, Maiden) | IEIN | BIRTHDATE (mm/dd/yyyy) | | --- | --- | --- | | ADDRESS (Street, City, State, ZIP Code) | TELEPHONE (Include Area Code) | | | | EMAIL | | NAME OF COLLEGE/UNIVERSITY | ADDRESS (Street, City, State, ZIP Code) | TELEPHONE (Include Area Code) | | --- | --- | | PART II -TO BE COMPLETED ONLY BY THE COLLEGE/UNIVERSITY | | Please verify that the above-named applicant has completed your state-approved program of preparation that, in your state, leads to a license comparable to gifted education specialist. The licensure officer, registrar, or other authorized official should provide the information [requested below and return the form to](requested below and return the form to licensureforms@isbe.net. Forms returned to the applicant or Regional Office of Education)[ ](requested below and return the form to licensureforms@isbe.net. Forms returned to the applicant or Regional Office of Education)[licensureforms@isbe.net](requested below and return the form to licensureforms@isbe.net. Forms returned to the applicant or Regional Office of Education)[.](requested below and return the form to licensureforms@isbe.net. Forms returned to the applicant or Regional Office of Education)[ Forms returned to the applicant or Regional Office of Education](requested below and return the form to licensureforms@isbe.net. Forms returned to the applicant or Regional Office of Education), will not be honored. AREA FOR WHICH APPLICATION IS BEING MADE GIFTED EDUCATION SPECIALIST (PreK–Grade 12) Yes Yes Yes No The completed program included clinical experiences with five or more students in both prekindergarten through grade 8 and grades 9 through 12. No For the purposes of the clinical experiences, the candidate has worked with at least one student enrolled in prekindergarten through grade 8 and at least one student enrolled in grades 9 through 12 and may have worked with a student one on one or in a group. No The clinical experience included coaching and mentoring one or more teachers on the topic of gifted education. | NAME OF COLLEGE/UNIVERSITY | TELEPHONE (Include Area Code) | | --- | --- | | ADDRESS (Street, City, State, ZIP Code) | EMAIL | Yes No I certify that the app

FAQs

Who should complete Part I of the form?

Part I is completed by the applicant after they have completed a state-approved program of preparation at a college or university.

What must the college or university verify in Part II?

The college or university must verify that the applicant completed a state-approved program leading to a license comparable to a gifted education specialist.

Are forms submitted or returned by the applicant accepted?

No. Forms submitted by the applicant or returned to the applicant or the Regional Office of Education will not be honored.

Oct 10, 2026

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