Substitute Teacher Permit Renewal Application 2016-17

Substitute Teacher Permit Renewal Application 2016-17

DEMOGRAPHIC INFORMATION


PLEASE TYPE IN ALL CAPS
 
Last Name*
 
First Name*
Middle Name
Date of Birth*
Example: mmddyyyy
 
Street Address*
 
City*
State*
 
Zip Code*
Contact Number*

The Michigan Department of Education (MDE) and Genesee ISD require a valid email address to contact you. Please enter your current or new email address. After August 1, 2016, the MDE will email the $45.00 substitute teacher permit payment link directly to you, unless you hold a valid Michigan Teacher Certificate. You must use the emailed link to remit payment using only a debit or credit card.

 

Has your email address changed since last year?*
Yes
No
Email Address (case sensitive)*

 

EMPLOYMENT STATUS


 
 
Michigan K-12 is defined as any public school, nonpublic school and/or public school academy in the state of Michigan. A few examples of "approved" education companies would be PESG, PCMI, EduStaff, Northstar and Communications Access Center. Please keep in mind that days worked in Michigan K-12 positions, other than substitute teaching, are accepted. For example, if you work as a paraprofessional, football coach, substitute secretary, and so on, you may count those as days worked. Days worked for YouthQuest, TeenQuest and private company tutoring services cannot be accepted.
 
Have you worked at least one day from JANUARY 1, 2016 - JUNE 30, 2016 for a Michigan K-12 school district or an "approved" education company?*
Yes
No
 
If a Michigan Department of Education (MDE) audit reveals that I have not worked as specified above, I must be fingerprinted again.*
 
I have read and understand the statement above.
 
Have you ever had a teaching, school counselor, school psychologist or school administrator certificate suspended or revoked?*
Yes
No
 
Is there currently action pending against your teaching, school counselor, school psychologist or school administrator certificate?*
Yes
No
 
Have you ever surrendered or nullified your teaching, school counselor, school psychologist or school administrator certificate?*
Yes
No
 
 
LEGAL INFORMATION

 
***IMPORTANT*** The Michigan Department of Education (MDE) requires applicants with a misdemeanor or felony charge (without final disposition) or conviction to provide specific legal documentation to determine permit and certificate eligibility. Failure to disclose this information may result in a revoked permit or certificate.
 
Prior to June 2016, have you ever been convicted of or pled no contest to a misdemeanor or felony? *
Yes
No
 
Have you ever provided legal documents to Genesee ISD pertaining to a misdemeanor or felony charge (without final disposition) or conviction? *
Yes
No
 
Since June 2016, have you been convicted of, pled no contest to, have current misdemeanor or felony charges against you? 1*
Yes
No
 
1 If you answered Yes to this question, before your permit can be processed, you will need to provide Genesee ISD with a Judgment of Sentence, Register of Actions, Certificate of Conviction and/or the Court Docket for any charge against you. Documents may be faxed to (810) 591-7570 or mailed/delivered to Genesee ISD, 2413 West Maple Avenue, Flint, MI 48507 Attention: Megan Kinsler.
 
Acknowledgement*
 
I have read and understand the statement above.
 
 
MILITARY EXPERIENCE

 
Have you ever served in the U.S. Armed Forces?*
Yes
No
 
Are you presently in the National Guard/Reserves?*
Yes
No
 
 
TYPE OF SUBSTITUTE TEACHER PERMIT

 
Please select only ONE of the following options:*
I need a substitute teacher permit. 2
I hold a valid Michigan Teacher Certificate. 3
I have applied for my Michigan Teacher Certificate. 4
My Michigan Teacher Certificate expired June 30, 2016. I need a substitute teacher permit.
 
2 After August 1, 2016, the MDE will email a $45.00 substitute teacher permit payment link directly to you, unless you hold a valid Michigan Teacher Certificate. You must use the emailed link to remit payment using only a debit or credit card. I understand that the Michigan Department of Education requires payment even if I decide not to substitute teach. Fee removal requests will NOT be granted. You may view your paid permit status at http://www.michigan.gov/moecs, then click “Educator Certification Verification.” Your paid permit will be valid from the date of payment and will expire on August 31, 2017.

3 I understand that I do not need a substitute teacher permit as long as my certificate is valid, but must complete a GISD substitute teacher renewal application each year. Once your application is processed, your information will be added to the 2016-17 Genesee ISD List of Substitute Teachers with a Valid Michigan Teacher Certificate.

4 I understand that if I want to substitute teach before my certificate's issue date, I will contact GISD.
 
* indicates a required field

 



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