21 Kansas Template

21 Kansas Template

The 21 Kansas form is an application process for individuals seeking to upgrade their Kansas teaching or school administrative license to a professional level. This comprehensive application requires detailed personal information, background checks, and verification of completion of an induction and mentoring program. For those looking to advance their careers in education within Kansas, ensure you have all necessary documents and information ready before clicking the button below to fill out your form.

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The Form 21 Application for Kansas Upgrade to Professional License is a comprehensive document designed to streamline the process for educators seeking an advanced level of certification within the state. This form is essential for applicants demonstrating their eligibility and readiness to hold a professional license, covering a wide range of information from personal identifiers like social security numbers and legal names to detailed academic and professional backgrounds. It requires disclosure of any past criminal activities, including felonies, misdemeanors involving theft, drugs, or children, and any disciplinary actions related to educational or professional conduct. Additionally, the form inquires about past actions that may affect an applicant's moral character or suitability for licensure, such as falsifying student assessments or experiencing disciplinary measures in any professional capacity. Applicants must list all degrees earned, signaling the achievement of higher educational standards, and attest to the truthfulness and completeness of their application under the penalty of license denial or revocation for misrepresentation. The inclusion of a verification process for an induction and mentoring program adds another layer of assurance to the state's licensing board that each applicant not only meets academic standards but also possesses the practical, mentor-reviewed experience required for a professional license. Finally, the Form 21 underscores the financial aspect of the application process with a specified fee, and it clearly states that the fee is non-refundable, highlighting the seriousness and commitment required from applicants seeking professional licensure in Kansas.

21 Kansas Preview

F O R M 21

Application for Kansas

Upgrade to

P R O F E S S I O N A L L I C E N S E

SECTION A – TO BE COMPLETED BY APPLICANT

1.

Social Security Number

___ ___ ___ - ___

___ - ___ ___

___ ___

 

 

 

 

 

 

 

 

 

 

2.

Legal Name

(First)

(Middle)

(Last)

 

 

 

 

 

 

 

 

 

3.

List all prior names (maiden, alias, previous married, etc.)

 

 

 

 

 

 

 

 

 

 

 

4.

Mailing Address

 

 

City

 

State

Zip Code

 

 

 

 

 

 

 

 

5.

Birthdate (MM/DD/YYYY)

6. Gender

7. Phone:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

 

 

Male

 

 

 

 

 

 

 

 

 

Female

Alternate Phone:

___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___

 

 

 

 

 

 

 

8. a. Have you ever been convicted of a felony?

 

 

 

 

 

NO

YES

If yes, please attach a copy of the court documents regarding conviction.

b.Have you ever been convicted of ANY crime involving theft, drugs, or a child?

NO

YES

If yes, please attach a copy of the court documents regarding conviction.

c.Have you entered into a criminal diversion agreement after being charged with any offense described in question 8a or 8b?

NO

YES

If yes, please attach a copy of the diversion agreement.

d.Are criminal charges pending against you in any state involving any of the offenses described in question 8a or 8b?

NO

YES

If yes, please attach a copy of the court documents regarding your case.

e.Have you had a teacher’s or school administrator’s certificate or license denied, suspended, revoked or been the subject of other disciplinary action in any state?

NO

YES

If yes, please indicate the action taken:

denied,

suspended or

revoked.

Which state(s)?

Please attach a copy of the documents regarding the official action taken.

f.Is disciplinary action pending against you in any state regarding a teacher’s or administrator’s certificate or license?

NO

YES

If yes, please attach a copy of the official documents regarding the action pending against you.

g.Have you ever been disbarred or had a professional license or state issued certificate denied, suspended, revoked or been the subject of other disciplinary action regarding any profession in Kansas or any other state?

NO

YES

If yes, please indicate the action taken:

denied,

suspended or

revoked.

Which state(s)?

Please attach a copy of the documents regarding the official action taken.

h.Have you ever been terminated, suspended, or otherwise disciplined by a local Board of Education for falsifying or altering student tests or student test scores?

NO

YES

If yes, which district(s)?

When?

i.Have you ever falsified or altered assessment data, documents, or test score reports required for licensure?

NO

YES If yes, what state(s)?

When?

 

 

 

9. List all degrees earned: (example: BA, MS, EDS, etc.) If you earned a new degree since your initial license, attach official transcripts.

Institution:_________________ Degree:__________ Year Earned:________

Institution:_________________ Degree:__________ Year Earned:________

Institution:_________________ Degree:__________ Year Earned:________

Institution:_________________ Degree:__________ Year Earned:________

10.I certify that I am of good moral character and that the information on this application is true and complete to the best of my knowledge. I understand that any misrepresentation of facts may result in the denial or revocation of my license.

Signature of Applicant

Date

Include a $54.00 Application Fee made payable to the Kansas State Department of Education.

 

 

Money order or cashier’s check preferred. Personal checks accepted.

 

 

DO NOT SEND CASH.

 

MAIL TO: Teacher Education and Licensure, KSDE, 120 SE 10th Avenue, Topeka, KS 66612-1182.

 

Processing fee CANNOT be refunded and does not guarantee a license will be issued.

 

Form 21 – Professional License

1

Revised 03-12

 

 

VERIFICATION OF AN INDUCTION AND MENTORING PROGRAM

Each conditionally or initially licensed teacher, school specialist or school leader must complete a year-long, district- administered induction and mentoring program to pass the performance assessment as a prerequisite to receiving a professional license.

Mentored Teacher/School Specialist/School Leader information

This form should be completed by the district or building administrator where the mentoring program occurred.

Name (First)

(Middle)

(Last)

 

 

 

Social Security Number ___

___ ___ - ___

___ - ___ ___ ___ ___

OR

 

 

Teacher identification number from license

_______________________________________

If the current school year is the mentor year, do not complete and submit until after May 15th

I verify:

The above named applicant successfully completed a year-long induction and mentoring program provided by the district. (By verifying this information, a professional license will be issued upon fulfillment of all other regulatory requirements.)

District Name and Number where mentoring occurred

Accreditation Information

NO YES

 

 

State Accredited School?

 

 

If not state accredited, attach verification of accreditation status.

Building Name

 

 

 

 

 

 

 

 

Beginning Date of mentored

Ending date of mentored

Assignment of teacher/school specialist/leader

Grade level

experience (MM/DD/YYYY)

experience (MM/DD/YYYY)

during mentored experience

 

 

 

 

 

 

 

 

 

 

 

Administrator’s Name (Please Print or Type)

Administrator’s Position

(May be district or building)

School Phone Number

Administrator’s Signature

Who was the mentor?

Date

_______________________________________________________

_________________________________

Mentor’s Name:

 

Mentor’s SS# or teacher ID#

 

 

 

Form 21 – Professional License

2

Revised 03-12

 

 

Form 21 – Professional License

3

Revised 03-12

 

 

Document Information

Fact Detail
1. Purpose Application for Kansas Upgrade to Professional License
2. Applicant Information Required Social Security Number, Legal Name, Prior Names, Mailing Address, Birthdate, Gender, Phone Numbers
3. Legal and Professional Background Checks Questions regarding convictions, disciplinary actions, terminations, or falsifications related to educational or professional standards
4. Education Credentials List of all degrees earned
5. Verification of Induction and Mentoring Program Confirmation required for completion of a year-long induction and mentoring program for conditionally or initially licensed teachers, school specialists or school leaders
6. Certification of Good Moral Character Applicant must certify their good moral character and the accuracy of information provided
7. Application Fee $54.00, non-refundable, payable to the Kansas State Department of Education
8. Document Submission Address Teacher Education and Licensure, KSDE, 120 SE 10th Avenue, Topeka, KS 66612-1182
9. Governing Laws Kansas Statutes and Regulations specific to teacher and educational administrator licensure

Guidelines on Utilizing 21 Kansas

Filling out Form 21 for a Kansas Upgrade to Professional License is an important step in advancing your teaching or administrative career in the state of Kansas. This process ensures that all the necessary information and documentation are in order for the Kansas State Department of Education to review your application. It's crucial to complete this form accurately and thoroughly to avoid any delays or issues with your license upgrade. Once submitted, your application will undergo a review process to ensure all qualifications and requirements are met. You will be informed of the decision or if further information is needed.

  1. Write your Social Security Number in the space provided.
  2. Enter your Legal Name: First, Middle, and Last.
  3. List all prior names you have gone by (maiden, alias, previous married, etc.).
  4. Provide your Mailing Address including City, State, and Zip Code.
  5. Fill in your Birthdate in the MM/DD/YYYY format.
  6. Select your Gender by checking the appropriate box.
  7. Enter your Phone Number, and if applicable, an Alternate Phone Number.
  8. For questions 8a through 8h, check 'YES' or 'NO' as applicable to your circumstances. If you answer 'YES' to any, attach the required documentation described in each question.
  9. List all degrees you have earned, specifying the Institution, Degree, and Year Earned for each. Attach official transcripts for any new degree earned since your initial license.
  10. Sign and date the form to certify the accuracy of your information and your understanding that any misrepresentation may affect your license status. Include the $54.00 Application Fee payable to the Kansas State Department of Education.
  11. Mail the completed form and any attachments to: Teacher Education and Licensure, KSDE, 120 SE 10th Avenue, Topeka, KS 66612-1182.

Note: The VERIFICATION OF AN INDUCTION AND MENTORING PROGRAM section should be completed by the district or building administrator where the mentoring program occurred. This is a requirement for all conditionally or initially licensed teachers, school specialists, or school leaders as a prerequisite to receiving a professional license.

Important Points on This Form

What is Form 21 in Kansas?

Form 21 is an application used in Kansas for individuals seeking to upgrade their teaching or school administration certification to a Professional License. The form requires personal details, educational history, a declaration of good moral character, and information on any criminal background or disciplinary actions in educational settings.

Who needs to complete Form 21?

Any teacher, school specialist, or school leader in Kansas looking to advance from an Initial or Conditional License to a Professional License must complete Form 21. This is a necessary step for educators aiming to further their careers within the state's educational system.

What information is required on Form 21?

Form 21 requires the applicant's Social Security Number, legal name, previous names if any, mailing address, birthdate, gender, contact information, criminal and disciplinary history within education or other professional fields, educational degrees earned, and a certification of good moral character. It also includes a section for verification of completion of a district-administered induction and mentoring program.

Is there a fee for submitting Form 21?

Yes, there is a $54.00 application fee for submitting Form 21. The Kansas State Department of Education accepts money orders, cashier’s checks, and personal checks. It's important to note that cash is not accepted, and the fee is non-refundable, regardless of the outcome of the application.

How do I submit Form 21?

Completed forms along with the necessary documentation and the application fee should be mailed to the Teacher Education and Licensure, KSDE, at the address provided on the form. It is crucial to ensure that all information is accurate and complete to avoid processing delays.

What happens if I've been convicted of a felony or other crimes?

If you've been convicted of a felony, a crime involving theft, drugs, or a child, have entered into a criminal diversion agreement, have criminal charges pending for such offenses, or experienced disciplinary action against a previous certificate or license, detailed documentation of each incident must be attached to your Form 21 application. The Kansas State Department of Education will review these materials as part of the licensing process.

Where can I find verification of completing the required induction and mentoring program?

The verification section is included in the Form 21 application and must be completed by the district or building administrator where the mentoring program occurred. It certifies that the applicant has successfully completed a year-long induction and mentoring program, a prerequisite for receiving a Professional License. Applicants should ensure this section is filled out accurately before submission.

Common mistakes

When filling out the Form 21 for a Professional License in Kansas, people often make several common mistakes that can delay the process, or worse, jeopardize their application. Being mindful of these errors can help ensure a smoother application process. Here are seven key mistakes to avoid:

  1. Not providing all previous names: Applicants sometimes forget to list all their prior names (including maiden, alias, or previous married names). This omission can cause delays in the verification process.

  2. Incorrect Social Security number: A surprisingly common error is entering an incorrect Social Security number. This mistake can lead to significant delays and complications with the application.

  3. Omitting required attachments: If you've answered "YES" to questions regarding past convictions, disciplinary actions, or license denials, you must attach the relevant court or official documents. Failing to attach these documents can halt the application process.

  4. Not providing details of disciplinary actions: When disclosing past disciplinary actions, it's crucial to provide complete details, including the action taken and the state(s) it occurred in. Vague or incomplete information will lead to further inquiries, slowing down the process.

  5. Forgetting to sign the application: An unsigned application is incomplete. Make sure to check that you've signed and dated your form to attest to the accuracy and completeness of the information provided.

  6. Missing application fee: The application fee is essential for processing your application. Failure to include the $54.00 fee (preferably via money order or cashier’s check) will result in your application not being processed.

  7. Not attaching official transcripts for newly earned degrees: If you've earned a new degree since your initial license was issued, you must attach official transcripts. Unofficial or missing transcripts can impede the approval of your upgraded license.

By avoiding these common errors, applicants can streamline their professional license application process, ensuring a timely and favorable review by the Kansas State Department of Education.

Documents used along the form

When embarking on the professional journey of becoming a licensed teacher in Kansas, the Form 21 application is a pivotal step. This document serves not just as an application but as a gatekeeper, ensuring that those who enter the education profession in Kansas have met certain standards and criteria. However, Form 21 does not stand alone in the application process. There are several other forms and documents that often accompany it, each serving a specific purpose in painting a full picture of an applicant's qualifications, legal standing, and readiness to take on the responsibilities of teaching. Let’s explore some of these additional documents.

  • Official Transcripts: These are required to verify the degrees listed on the application. They must be sent directly from the institutions where the degrees were earned to the Kansas State Department of Education (KSDE).
  • Verification of Teaching Experience: This form, or an official document from previous employers, is necessary for applicants who are claiming teaching experience as part of their qualifications. It validates the type, length, and quality of prior teaching roles.
  • Fingerprint Clearance Card: A crucial security measure, this document is necessary for conducting a background check on the applicant to ensure the safety of students.
  • Professional References: Letters or forms that provide qualitative assessments of the applicant's professional abilities, character, and suitability for teaching by former employers, colleagues, or academic instructors.
  • Praxis Scores: These are required if the applicant is coming from another state and needs to meet Kansas content and pedagogy testing requirements. The scores must be sent directly from the Educational Testing Service (ETS) to the KSDE.
  • Professional Development Hours Documentation: For applicants seeking to upgrade or renew their licenses, evidence of continuing education through professional development is required to ensure teachers remain current in their subject area and teaching methods.
  • Verification of Induction and Mentoring Program Completion: This confirms that the applicant has successfully completed a state-approved mentoring program, a critical step for initial licensure in Kansas.
  • Court Documents: For applicants who answered "yes" to any of the legal background questions on Form 21, providing copies of court documents related to convictions, diversion agreements, or disciplinary actions is mandatory to evaluate their eligibility for licensure.
  • License Upgrade Form: For existing teachers in Kansas looking to advance their license to a higher level or add endorsements, an additional form detailing the specific upgrade sought is necessary alongside Form 21.

Together with Form 21, these documents create a comprehensive portfolio that KSDE reviews to make informed decisions about granting professional teaching licenses. This process ensures that educators not only possess the requisite academic qualifications but also the moral and professional character to shape the future of Kansas's students. In the world of education, where the stakes are the future of our children, this thorough approach to licensure safeguards the quality and integrity of teaching in Kansas.

Similar forms

  • The 21 Kansas form is similar to the Universal Application for Teaching Positions used in multiple states across the U.S. Both forms require comprehensive personal information, including social security number, legal name, and contact details. They aim to gather a detailed educational and professional background from the applicant. This is to ensure that candidates meet the criteria for the positions they are applying for. Additionally, both forms include questions about past criminal convictions, especially those that might impact one's ability to work safely with children or within a school setting. The significance of these similarities lies in their joint goal to maintain high standards of integrity and professionalism within the education sector.

  • Another document resembling the 21 Kansas form is the Application for Professional License Renewal. While the latter focuses on renewing an existing license, both solicit crucial background information that could affect the applicant's eligibility. This includes any criminal history, disciplinary action taken against professional licenses, or issues with previous employment that may question the applicant's suitability for licensure. Both documents require verification of continuing education or induction and mentoring programs, emphasizing the importance of ongoing professional development in the maintenance and advancement of professional standards.

  • Similarly, the 21 Kansas form shares commonalities with the National Board Certification Application. Both are aimed at educators seeking to enhance their qualifications, although the national board certification focuses on demonstrating advanced teaching practice. They request detailed educational histories, including degrees earned and institutions attended, and require applicants to attest to their moral character and integrity. These forms also ask the applicant to disclose any previous disciplinary actions or criminal convictions, underscoring the education community's commitment to safety and excellence.

Dos and Don'ts

When completing the 21 Kansas form for application to upgrade to a professional license, there are certain practices you should follow and others to avoid to ensure the process is smooth and successful. The following lists provide a guide to help you navigate this process with ease.

Things You Should Do:

  1. Ensure all personal information, including your Social Security Number and legal name, is accurate and matches your official documents.

  2. Answer questions regarding criminal history and professional discipline truthfully, attaching all required court or official documents.

  3. Include all prior names (maiden, alias, previous married, etc.) to avoid any discrepancies in your application.

  4. Attach official transcripts for any new degrees earned since your initial license was issued.

  5. Sign the application to certify your character and the veracity of the information provided, and include the correct application fee via a money order, cashier’s check, or personal check.

Things You Shouldn't Do:

  1. Do not leave any section incomplete, as missing information can delay the processing of your application.

  2. Avoid providing false or misleading information, as this can lead to the denial or revocation of your license.

  3. Do not send cash for the application fee to ensure there is a record of payment and to prevent theft or loss.

  4. Refrain from sending unofficial transcripts; only official copies will be accepted to verify your education credentials.

  5. Do not overlook the need to attach documentation for any "Yes" responses to questions regarding legal or professional history, as failure to do so can result in application rejection.

Misconceptions

Many people have misconceptions about the Kansas Form 21, which is necessary for upgrading to a professional license. Understanding these misconceptions can help applicants navigate the process more effectively.

  • All criminal history is an automatic disqualification: While the form asks about criminal convictions, not all of them automatically disqualify an applicant. The details, such as the nature of the offense and how long ago it occurred, are considered on a case-by-case basis.

  • Only felony convictions need to be disclosed: The form explicitly asks about any convictions involving theft, drugs, or a child in addition to felony convictions. This includes misdemeanors and other criminal offenses, not just felonies.

  • Diversion agreements are not relevant: If you've entered into a criminal diversion agreement after being charged with an offense described on the form, it must be disclosed. These agreements are treated seriously and require documentation.

  • Pending disciplinary actions do not need to be mentioned: Whether or not an action has been finalized, any pending disciplinary action against a teaching or administrative license must be disclosed.

  • Misrepresentation of facts on the form is a minor issue: Falsifying, altering, or omitting required information can lead to denial or revocation of the professional license. Honesty on the form is paramount.

  • All professional discipline issues must be from Kansas: The form inquires about any disciplinary action regarding a professional license or certificate in any state, not just Kansas. This includes being disbarred or having a license denied, suspended, or revoked elsewhere.

  • Termination by a Board of Education for ethical breaches is irrelevant: Any disciplinary action taken by a local Board of Education, especially for falsifying or altering student tests or scores, must be disclosed. This is taken very seriously in the licensure process.

  • Previously earned degrees do not need to be listed: All degrees, irrespective of when they were earned, should be listed on the form. If a new degree has been earned since the initial license, official transcripts must be attached.

  • The application fee guarantees licensure: Payment of the application fee is a requirement of the application process, but it does not guarantee a license will be issued. It covers the processing and review of the application.

Understanding these points can help clarify the licensure process and prevent errors or omissions that may delay or impede the issuance of a professional license in Kansas.

Key takeaways

Filling out and using the Form 21 in Kansas, which is an Application for Upgrade to Professional License, requires careful attention to detail and honesty. Below are key takeaways intended to guide applicants through the process.

  • Complete all sections accurately: Ensuring that every section of the Form 21 is filled out accurately is crucial. This includes providing your social security number, legal name, any prior names, and your contact information.
  • Report past convictions and disciplinary actions: It is mandatory to disclose any past criminal convictions, especially those involving felonies, theft, drugs, or children. Additionally, any previous disciplinary actions against professional licenses must be reported.
  • Attach required documents: When answering questions related to past convictions or disciplinary actions, attaching copies of the relevant court or official documents is a vital step in the application process.
  • Education details are important: Listing all degrees earned, along with the institutions, degrees, and years they were earned, is necessary. For any new degrees since your initial license, official transcripts must be attached.
  • Character certification: By signing the form, applicants certify that they are of good moral character and that the information provided is true and complete to the best of their knowledge. It's a declaration that underscores the importance of honesty throughout the process.
  • Application fee: The form makes it clear that a $54.00 application fee is required, highlighting acceptable payment methods. It also notes that this fee is non-refordable and does not guarantee that a license will be issued.
  • Verification of induction and mentoring program: Part of the process includes verifying that the applicant has completed a year-long, district-administered induction and mentoring program. This is essential for the issuance of a professional license upon fulfillment of all other requirements.
  • Accurate mentor and program details: Applicants must ensure that the mentoring program details, including the district name and number, accreditation information, and dates of the mentored experience, are correctly reported. The mentor's information must also be accurately provided.
  • Understand the implications of falsifying information: Falsification or alteration of any required assessment data, documents, or test score reports can result in serious consequences, including the denial or revocation of the professional license. This underscores the need for transparency and accuracy in the application process.

Following these guidelines not only ensures that the applicant fulfills the statutory requirements but also reinforces the commitment to professional integrity and ethical standards in the field of education in Kansas.

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