Department Application for Professional Educator License for School Counseling Endorsement

Northern Illinois University Department of Counseling and Higher Education

This application needs to be completed in order to apply for the Professional Educator License (PEL) with an endorsement in School Counseling. Please read this carefully, complete ALL the information below, provide all necessary attachments, and submit to the CAHE Department via email to CAHE@niu.edu before your last semester of internship. Be sure ALL transcripts and materials are submitted with the form. Do Not submit an independent application through the Illinois School Board of Education (ISBE).

Z-ID

Personal Email address:

Name

Permeant phone:

Academic Advisor in Counseling Program

Section 1 (Check one)

_____ I have completed NIU’s 60-hour counseling program. Graduation date: (circle one) MAY AUG DEC _____ (year)

_____ I have completed The School Counselor Institute at NIU. Completion date: (circle one) MAY AUG DEC _____ (year) The certificate of completion for the School Counselor institute is attached.

Section 2 (Check one)

_____ I currently hold a Professional Educator License (photocopies must be submitted). My current endorsement is: __________________________________ IEIN# ___________________ (skip to Section 5)

_____ I do not hold a Professional Educator License, but have my IEIN# ________________ and have completed:

Questions regarding the completion of the following requirements should be directed to your advisor or the counseling program licensure liaison via email to cahc_internship@niu.edu

Section 3 (check one)

I have completed the 2013 ISBE requirements for Reading/Literacy, SEL, and ELL as in accordance with State Rules in the following way:

_____ The material was covered in the following graduate class in the NIU master’s program (circle correct answer)

CAHC 523 Semester/Year Professor and/or CAHC 586 Semester/Year Professor

_____ The material was covered through the completion of an approved NIU workshop.

Workshop Title Date Instructor

_____ Other: Explain:

Student First Name, Last Name, Middle Initial

Section 4 Completion of other Teaching Requirements from ISBE As required by ISBE, coursework must be documented in the following areas if the student does not hold a current teaching license through ISBE. If the student has not attached a copy of a current teaching license, each of the areas below must be filled out indicating where the student fulfilled these requirements. PLEASE NOTE: if these classes were taken outside of NIU, transcripts must be attached.

_____ Climate of the School (Curriculum Instruction)

Course Title:

Institution:

Date Completed: _________________

_____ Classroom Management

Course Title:

Institution:

Date Completed: _________________

_____ Child and Adolescent Development (EPS 710 or CAHC 510)

Course Title:

Institution:

Date Completed: _________________

_____ Working with Exceptional Populations (Exceptional Child)

Course Title:

Institution:

Date Completed: _________________

Section 5 Final Submission of all paperwork (Check all materials that you have enclosed with this form) Be certain that all materials listed below accompany this form.

______ Gender/Ethnicity Form (Required)

______ Photocopy of official transcript(s) from all undergraduate and graduate degree institutions, other than NIU (You must submit these with your application)

__________ Undergraduate degree (other than NIU)

__________ Graduate degree (other than NIU)

__________ Graduate course work (other than NIU)

______ Photocopies of all valid teaching certificates or licenses (if applicable)

______ Photocopy of School Counselor Institute Certificate (School Counselor Inst. Students ONLY)

NOTE: We will NOT be able to process your application if ALL the necessary information is not included.

Completion of course requirements and/or deficiencies for the appropriate endorsement will be verified by the Department and the University Office of Educator License and Preparation. This process usually takes up to one month after all materials have been submitted and degree has been conferred to your transcript. Once this process is completed, NIU will recommend you to the Illinois State Board of Education (only the state can issue a professional license) by verifying completion of NIU’s approved Professional Educator License program with an endorsement in School Counseling. You will be notified that this recommendation has been made, and will then need to complete the online application or verification of application through your ELIS account along with submitting applicable licensure fees in order to complete the process of PEL licensure activation through ISBE.

If any of this process is unclear, check with your advisor or contact the counseling program licensure liaison via e- mail to cahc_internship@niu.edu or CAHE@niu.edu We wish you the best in receiving your Professional Educator License.

NOTE ON SUBMISSION: Submit all materials (i.e., application, transcripts, and gender/ethnicity form) as a single unit in electronic copy. To submit materials electronically, scan and email your application, transcripts, and gender/ethnicity form to CAHE@niu.edu and write PEL Application in the subject line.

Gender & Ethnicity Form

PLEASE COMPLETE THE FOLLOWING:

Gender Information: Sex

Ethnic Information:

TO MONITOR COMPLIANCE WITH CIVIL RIGHTS LEGISLATION, FEDERAL AND STATE AGENCIES REQUIRE UNIVERSITIES TO DESCRIBE THEIR RACIAL/ETHNIC POPULATIONS. YOUR RESPONSE TO

THIS ITEM IS OPTIONAL. THE INFORMATION SUPPLIED IS USED FOR RESEARCH PURPOSES ONLY

AND WILL NOT AFFECT YOUR ADMISSION. PLEASE CHECK THE CATEGORY THAT BEST DESCRIBES YOUR RACIAL/ETHNIC BACKGROUND.

1 __ American Indian 2 ___ Latino 4 ___ African American (Not of Latino origin) or Alaskan Native 3 ___ Asian or Pacific Islander 5 ___ White (not of Latino origin)

NAME: ____________________________________

Z-ID: ____________________________________

NOTE: To be included with application for certification paperwork sent to our office.

F = FEMALE M = MALE

Student First Name, Last Name, Middle Initial

Dep

Dep

Tes

Stu

Adv

Northern Illinois University

___

Student First Name, Last Name, Middle Initial Z ID/ EMPL ID Number Date of Birth

Program - Specialization IEIN Number Date Admitted to Program - Semester/Year

artment  Course Number  An cipated Comple on Date 

artment  Course Number  Department   Course Number 

t  Name  Date Completed  Pending Results  Verified in MyNIU and ELIS Account 

Date 

Date dent Signature 

isor/Program Coordinator 

__________________________________________________________________________________________

Safety Tutorial Completed Required Coursework C or Better