[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-535885-en":3,"doc-seo-535885-105":30,"detail-sidebar-cat-0-en-105":96},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29,"preview_page_count":4},535885,2336475401981,"Chumphorn","https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694",4,"Exam","STATE-APPROVED PROGRAM VERIFICATION FOR GIFTED EDUCATION SPECIALIST ONLY - PART I - TO BE COMPLETED BY APPLICANT","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.","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.   \n100 North First Street, E-240 Springfield, Illinois 62777-0001  \n!73-05G  \nSTATE-APPROVED PROGRAM VERIFICATION FOR GIFTED EDUCATION SPECIALIST ONLY  \nEDUCATOR EFFECTIVENESS DEPARTMENT  \nPART I - TO BE COMPLETED BY APPLICANT  \nAn 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.  \n\n| APPLICANT'S NAME (Last, First, Middle, Maiden) | IEIN | BIRTHDATE (mm/dd/yyyy) |\n| --- | --- | --- |\n| ADDRESS (Street, City, State, ZIP Code) | TELEPHONE (Include Area Code) |  |\n|  | EMAIL |  |\n\nNAME OF COLLEGE/UNIVERSITY  \n\n| ADDRESS (Street, City, State, ZIP Code) | TELEPHONE (Include Area Code) |\n| --- | --- |\n| PART II -TO BE COMPLETED ONLY BY THE COLLEGE/UNIVERSITY |  |\n\nPlease 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.  \nAREA FOR WHICH APPLICATION IS BEING MADE  \n GIFTED EDUCATION SPECIALIST (PreK–Grade 12)  \n Yes  \n Yes  \n Yes  \n No The completed program included clinical experiences with five or more students in both prekindergarten through grade 8 and grades 9 through 12.  \n 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.  \n No The clinical experience included coaching and mentoring one or more teachers on the topic of gifted education.  \n\n| NAME OF COLLEGE/UNIVERSITY | TELEPHONE (Include Area Code) |\n| --- | --- |\n| ADDRESS (Street, City, State, ZIP Code) | EMAIL |\n\n Yes  No I certify that the 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