Appendix E Revised: 7/1/17

The Jefferson County Educational Service Center Consortium Local Professional Development Committee

Checklist / Cover Page for the License Renewal Packet

Part I.	To be Completed by Educator Applicant

_______________________ Applicant’s Name

_______________________ Building

_______________________ Assignment

Please Note:	It is the Responsibility of the Applicant to make sure you have complied with the current BCI and FBI Background Checks Standards.

Part II.	To be Completed by the Applicant & Verified by the Superintendent’s Secretary

Directions: Check each Item to Verify Inclusion in the Renewal Packet.

Applicant	Secretary

	 Initial IPDP Only (For those Educators Transitioning from Resident Educator License to Regular 5-Year Professional License)

	 Application to ODE - Completed Online / Payment - Completed Online

	 Copy of Expiring License(s) / Certificate(s)

	 New IPDP (For Renewals)

	 Original Transcripts (No Copies will be Accepted)

	 Verification that all Coursework and CEU work was completed

	 Original CEU Forms

	 Completed “Summary of PD Activities” Form (Appendix M)

Signature, Superintendent’s Secretary

Part III.	To be Completed by the Superintendent

Signature, Superintendent

Date

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