The 21 Kansas form is an application used by individuals seeking an upgrade to a professional license in Kansas. This form requires personal information, including your legal name, social security number, and details about any prior names. Completing this form accurately is crucial for ensuring your application is processed without delays; please fill it out by clicking the button below.
The 21 Kansas form serves as a crucial application for individuals seeking to upgrade to a professional license in the state of Kansas. This form is divided into several sections, each designed to gather essential information from the applicant. Section A requires the applicant to provide personal details such as their legal name, social security number, mailing address, and contact information. Additionally, it prompts applicants to disclose any prior names and their date of birth, along with gender identification. A significant aspect of this form is its focus on the applicant's legal history, which includes inquiries about felony convictions, disciplinary actions related to teaching credentials, and any pending criminal charges. Applicants must also confirm their moral character and attest to the accuracy of the information provided. Furthermore, the form requires documentation of educational qualifications, including degrees earned and transcripts if applicable. A $54 application fee is also mandated, reinforcing the importance of a complete and accurate submission. Lastly, the form addresses the verification of an induction and mentoring program, a prerequisite for obtaining a professional license, emphasizing the commitment to professional development within the educational field.
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?
c.Have you entered into a criminal diversion agreement after being charged with any offense described in question 8a or 8b?
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?
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?
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?
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?
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?
If yes, which district(s)?
When?
i.Have you ever falsified or altered assessment data, documents, or test score reports required for licensure?
YES If yes, what state(s)?
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:________
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)
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)
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?
_______________________________________________________
_________________________________
Mentor’s Name:
Mentor’s SS# or teacher ID#
2
3
Completing the 21 Kansas form is a straightforward process, but attention to detail is essential. The information you provide will be reviewed carefully, so ensure accuracy and completeness. Gather the necessary documents before you begin, as some sections require additional documentation to support your application.
After submitting your application, it will be processed by the Kansas State Department of Education. Make sure to keep copies of everything you send for your records. The processing fee is non-refundable, and submitting your application does not guarantee that a license will be issued.
The 21 Kansas form, officially known as the Application for Kansas Upgrade to Professional License, is designed for individuals seeking to upgrade their teaching credentials in Kansas. This form collects essential information about the applicant's background, education, and any legal issues that may affect their eligibility for a professional license.
Applicants must provide a variety of personal details, including:
Additionally, you will need to disclose any felony convictions, criminal charges, or disciplinary actions related to teaching or professional licenses. Finally, you must list all degrees earned and certify the truthfulness of your application.
The application fee for the 21 Kansas form is $54. This fee should be made payable to the Kansas State Department of Education. Acceptable payment methods include money orders, cashier’s checks, or personal checks. It is important to note that cash should not be sent with the application. The processing fee is non-refundable and does not guarantee that a license will be issued.
If you have been convicted of a felony or any crime involving theft, drugs, or a child, you must disclose this information on the form. Attach copies of relevant court documents. The same applies if you have pending criminal charges or have entered into a criminal diversion agreement. Failure to disclose this information may result in the denial or revocation of your license.
To qualify for a professional license, conditionally or initially licensed teachers must complete a year-long, district-administered induction and mentoring program. This program is essential for passing the performance assessment required for licensing. The district or building administrator must verify successful completion of this program on the form.
Once you have completed the form and included the necessary payment, mail it to:
Ensure that all required documentation is attached to avoid delays in processing your application.
Failing to provide a complete legal name in the designated section. All names, including middle names, should be accurately filled out.
Neglecting to list all prior names, such as maiden names or aliases. This can lead to discrepancies during the application process.
Omitting the social security number or providing an incorrect one. This information is critical for identification and processing.
Incorrectly entering the birthdate. The format must be MM/DD/YYYY, and any deviation can result in delays.
Not indicating the gender option. This section must be completed to avoid processing issues.
Failing to answer questions regarding criminal history truthfully. Misrepresentation can lead to severe consequences, including denial of the license.
Forgetting to attach necessary court documents for any affirmative answers related to criminal history. This documentation is essential for review.
Not listing all degrees earned or failing to attach official transcripts for any newly acquired degrees since the initial license.
Overlooking the signature section. The application must be signed and dated to be considered valid.
Not including the $54.00 application fee or using an improper form of payment. Adhering to payment guidelines is crucial for processing.
The 21 Kansas form serves as an essential document for individuals seeking a professional license in the state of Kansas. Alongside this application, several other forms and documents are commonly required to ensure a comprehensive review of the applicant's qualifications and background. Below is a list of these documents, each playing a crucial role in the licensing process.
These documents, in conjunction with the 21 Kansas form, contribute to a thorough evaluation process. Each form serves a specific purpose, helping to ensure that only qualified individuals receive a professional license to teach or lead in Kansas schools.
The Kansas Form 21, which is an application for upgrading to a professional license, shares similarities with the Application for Licensure by Endorsement. Both documents require applicants to provide personal information, including their social security number, legal name, and contact details. Additionally, both forms inquire about any past criminal convictions or disciplinary actions that could impact the applicant's eligibility for licensure. This ensures that the licensing boards have a comprehensive understanding of the applicant's background before making a decision.
Another document that resembles the Kansas Form 21 is the Teacher Certification Application. Like the Form 21, this application collects vital information about the applicant's education, including degrees earned and institutions attended. Both forms also emphasize the importance of good moral character, requiring applicants to certify that the information provided is accurate and complete. This parallel underscores the commitment to maintaining high standards in the teaching profession.
The Professional License Renewal Application is also similar to the Kansas Form 21. Both documents require detailed information about the applicant's professional history and any continuing education completed since the last license was issued. They both aim to ensure that educators remain qualified and up-to-date with the latest practices in education. This focus on ongoing professional development is crucial for maintaining quality education standards.
The Background Check Authorization Form shares a common goal with the Kansas Form 21, as both require applicants to disclose any criminal history that may affect their ability to work in education. While the Form 21 asks for specific details about convictions and pending charges, the Background Check Authorization Form facilitates a more comprehensive examination of the applicant's criminal record through official channels. This process helps protect students and maintain a safe learning environment.
Similarly, the Induction Program Completion Form is aligned with the Kansas Form 21 in that both emphasize the importance of mentorship and support for new educators. The Induction Program Completion Form verifies that the applicant has successfully completed a year-long mentoring program, which is often a prerequisite for obtaining a professional license. This requirement ensures that new teachers receive the guidance necessary to thrive in their roles.
The Application for Alternative Certification also mirrors the Kansas Form 21 in its focus on collecting personal and educational information. Both forms require applicants to demonstrate their qualifications and moral character, while also addressing any past disciplinary actions. This similarity reflects the broader goal of ensuring that all educators meet specific standards before being granted a license to teach.
The License Application for School Administrators shares common features with the Kansas Form 21. Both documents ask for detailed information about the applicant’s educational background and any previous certifications or licenses held. They also require disclosures related to criminal history and disciplinary actions. This thorough vetting process is essential for maintaining the integrity of educational leadership positions.
The Application for Special Education Certification is another document that aligns with the Kansas Form 21. Both applications require candidates to provide extensive personal and educational details, along with information about any criminal history or past disciplinary actions. This ensures that only qualified individuals are allowed to work with vulnerable populations, such as students with special needs.
The Application for Professional Development Credit is similar in its focus on ongoing education and professional growth. Both forms require applicants to outline their educational experiences and any relevant coursework completed. This emphasis on continuous learning is vital for ensuring that educators remain effective and knowledgeable in their fields.
Finally, the Educator Ethics Disclosure Form complements the Kansas Form 21 by requiring applicants to disclose any ethical violations or misconduct. While the Form 21 focuses on criminal history and disciplinary actions, the Educator Ethics Disclosure Form specifically addresses ethical considerations that may affect an applicant's suitability for licensure. Together, these documents help maintain high ethical standards within the education profession.
When filling out the 21 Kansas form, it is essential to approach the task with care and attention to detail. Here are some important do's and don'ts to keep in mind:
Taking these steps can help ensure that your application is processed smoothly and efficiently. Remember, accuracy and honesty are key in this process.
Misconceptions about the 21 Kansas form can lead to confusion and delays in the application process. Here are nine common misunderstandings:
Understanding these misconceptions can help applicants navigate the process more effectively and ensure a smoother transition to obtaining their professional license in Kansas.
Filling out the 21 Kansas form is an important step for individuals seeking to upgrade to a professional license. Here are key takeaways to keep in mind:
By following these guidelines, applicants can help ensure a smooth application process for their professional license in Kansas.