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Professional Teaching

Standards Board

Wyoming Educator Permit Initial or Reinstatement

Application Packet

This Packet is to apply for an Initial or Reinstatement of the following

Wyoming Educator Permits:

• Substitute or Lifetime Substitute Teacher

• Head, Assistant, or Transitional Coaching • Native Language

• Internship • Professional, Industry, and Careers (PIC) • Educational Sign Language Interpreter (ESLI)

• Driver’s Education

Submit your complete application packet to:

Professional Teaching Standards Board 1920 Thomes Avenue, Suite 100

Cheyenne, WY 82002

- 2 - FORM_BLUE_PERMIT Updated 11/15/2019

Application Instructions Initial or Reinstatement Educator Permit

Tips for Applicants • Before completing your application, read all instructions carefully.

• In order for PTSB to better serve you by processing your application quickly and efficiently, it is critical that submitted application packets are complete and contain all supporting documentation as outlined in the instructions and on the forms.

• PTSB does NOT accept photocopied, faxed, or scanned applications. • Application processing times vary throughout the year and depend upon whether an applicant is

required to submit fingerprints cards or not. Check our current processing time by visiting the PTSB homepage: http://wyomingptsb.com.

• It is the applicant’s responsibility to maintain current information (including Name, Mailing Address, Phone Number, and Email Address) on file with the Professional Teaching Standards Board.

o To update your information please contact our office at 307-777-7291.

Application Process

Step 1 — Complete the Wyoming PTSB Application Form

• Read ALL sections of the application packet carefully before completing. • Section I – APPLICANT INFORMATION (Page 6)

o Complete the information as outlined. • Section II – LICENSING AND LEGAL INFORMATION (Pages 6 and 7)

o Please make sure you carefully read and complete pages 6 and 7 of the application. o Any disclosure must be accompanied by a personal statement indicating the circumstances and

other related legal documentation (if applicable) to be considered complete. For more information regarding your personal statement, see page 6.

o Failure to disclose will delay your application. This may also lead to forfeiture of your fee, denial,

or cancelation of your application. o If you have any questions regarding your particular circumstance(s), please contact our office at

307-777-7291. o Sign and date the application (see bottom of page 7)

• Section III – INDIVIDUAL PERMIT REQUIREMENTS o Complete all boxes in this section which are applicable to you and gather any documentation

required.

Step 2 — Complete fingerprint cards [if applicable]

• Applicants must provide fingerprints on two original blue (FBI) fingerprint cards regardless of how recently fingerprints were taken in another state or for any other purpose.

Note: If you currently hold a valid Wyoming license or permit through PTSB, you do not

need to submit new fingerprint cards. • Applicants may obtain fingerprint cards and be fingerprinted by any law enforcement agency.

o If the local law enforcement agency will not provide two blue (FBI) fingerprint cards, applicants may email PTSB at [email protected] with applicant’s name and mailing address to request cards.

• Include both blue fingerprint cards with your complete application packet.

• BEFORE submitting your fingerprint cards, be aware of the following conditions: o Fingerprint cards MUST be completed in black ink only. o Fingerprint cards MUST NOT be folded, stapled, or mutilated in any way. o Fingerprint cards MUST NOT contain any smudged or unreadable prints.

Applicants who submit fingerprint cards not adhering to the above conditions may be requested by the Wyoming Division of Criminal Investigation to send in a second set of fingerprint cards, delaying their application.

http://wyomingptsb.com/

mailto:[email protected]


Complete the following fields on BOTH of the BLUE (FBI) fingerprint cards:

Left Side Applicant completes: Signature of Person Fingerprinted and Residence of Person Fingerprinted Official completes: Date and Signature of Official taking the Fingerprints

Middle

Column

Applicant completes: Last Name, First Name, Middle Name (top of card), Aliases (if

applicable), Citizenship, Social Security Number

Right side Applicant completes: Sex, Race, Height, Weight, Eyes, Hair, Date of Birth, Place of Birth

Step 3 — Provide verification of coursework (Page 16) [if applicable]

• Request official transcripts from ALL colleges and universities where coursework has been completed and have them sent directly to you. Include the official transcripts with your completed application packet. No photocopied, faxed, or scanned copies are accepted.

o If you are submitting electronic transcripts please see page 16 for more information. • Transcripts must have your degree posted. Transcripts without the degree posted cannot be

processed unless a degree was not earned at that institution. Note: It is not necessary to submit official transcripts in a separate, sealed envelope; however, transcripts must contain the institution’s original seal and registrar’s signature in order to be considered “official”.

• Educational Sign Language Interpreter (ESLI) applicants may use the Institutional Recommendation (see page 14) as a possible route toward receiving a permit from PTSB.

Step 4 — Demonstrate U.S. and Wyoming Constitution knowledge (Page 17) [if

applicable]

• If you currently hold or have ever held a license or permit through PTSB, you do not need to demonstrate knowledge of the U.S. and Wyoming Constitutions again.

• Applicants are required to demonstrate knowledge of both the U.S. and Wyoming Constitution either

through an exam or college course(s). Course(s) must be passed with a grade of a “C” or better.

• If you have not completed a college course(s) to meet the U.S. and Wyoming Constitution, you may

demonstrate knowledge through an exam with a passing score. Exam(s) may be taken at a Wyoming school district office or the PTSB office. Out-of-state applicants may have these exams proctored in their state (see page 17 for more information).

• U.S. and Wyoming Constitution Study Guides are available at: http://ptsb.state.wy.us/Licensure/BecomingLicensed/USWyomingConstitution/tabid/153/Default.aspx

• Complete the Verification of Constitution Knowledge form and include exam results or an official transcript indicating course(s) that meet these requirements with your complete application packet.

Step 5 — Provide results for testing requirements [Driver’s Ed Only]

• For individuals applying for a Driver’s Education Permit, a Driver Education Exam is required. Please contact the PTSB Board Office at 307-777-7291 for more information.

Step 6 — Reinstatement Applicants [if applicable]

Reinstatement is for any applicant who has previously held a permit in Wyoming and is seeking

reinstatement of that expired permit.

• Reinstatement applicants must meet all of the requirements listed on their previously held Wyoming Educator permit. A complete list of those requirements can be found on the reverse side of the applicant’s previously issued permit.

• All reinstatement applicants must provide new fingerprint cards and the $50 fingerprint processing fee with their application.

Note: This is only required if you do not have a current and valid permits or license (coaching, PIC permit, etc.) on file with PTSB

• In addition, reinstatement applicants must complete five (5) semester hours of either PTSB-

approved workshop credits or college course(s) from an accredited institution of higher education and must meet any additional requirements that fall under current permit requirements for their endorsement area(s).

Note: Reinstatement applicants seeking a coaching endorsement will need to meet current

requirements.

http://wyomingptsb.com/professional-development/


Step 7 — Complete the Fee Payment Form including all applicable fees (Page 18)

• If you do not currently hold a valid license or permit through PTSB, be sure to include the $50 fingerprint processing fee.

• Personal checks, cash, money orders, cashier’s check, and credit card payments are accepted. o Please make checks payable to PTSB or Professional Teaching Standards Board.

Step 8 — Submit your complete application packet to PTSB

• Your complete application packet should be submitted with the documents listed in the checklist

below:

Submit your complete application packet to:

Professional Teaching Standards Board

1920 Thomes Avenue, Suite 100

Cheyenne, WY 82002

WYOMING PTSB APPLICATION CHECKLIST (Check the appropriate box next to EACH item included)

I have included two original blue (FBI) fingerprint cards [if applicable] (see pages 2 and

3)

I have completed Sections I and II – Legal and Licensing Information (see pages 6 and 7)

I have included a personal statement and court documents [if applicable] (see pages 6 and 7)

I have completed Section III – Individual Permit Requirements (see page 8)

I have included the Institutional Recommendation form(s) complete with university seal

[if applicable] (see page 14) (ESLI applicants ONLY)

I have included the Verification of Employment form [if applicable] (see page 15) (for Transitional Coaching, PIC, and Native Language applicants ONLY)

I have included official transcripts from all institutions I have attended with degree(s) posted [if applicable] (see page 16) (photocopied, faxed, or scanned transcripts are not accepted)

I have included the Verification of Constitution Knowledge form [if applicable] (see page 17)

I have included my Driver Education Exam scores (Driver’s Education applicants ONLY)

I have included current copies of my 1st Aid/CPR card(s) [if applicable] (Coaching applicants ONLY)

I have included credit card information, money order, or a check payable to the PTSB or Professional Teaching Standards Board (see page 18)


Step 9 — Monitor application status

• You may check the status of your application at any time by logging in to the PTSB website at http://wyomingptsb.com.

How to check your status: Step 1: Log in to your account. If you don’t already have an account, you will need to click “register now” and create an account.

Step 2: Select “Educator Section: Click Here”

Step 3: Select “View Report of your Licensing Information”

Step 4: Underneath the applicant information section you will see the following:

Estimated application processing times:

These processing times are just estimates; they can be shorter or longer depending on

each individual situation.

Help Us Avoid Processing Delays Our goal is to process your application and issue your Educator Permit in a timely manner. To do

that, we ask that you submit your application packet with complete and accurate information.

If an application is received incomplete, you will receive a 30 Day Notice notifying you of your

missing requirements. If the missing item(s) are not received within the 30 days, your application

may be canceled and your fee may be forfeited.

Fingerprints During the School Year During the Summer Months

NOT REQUIRED Two–to-four weeks Four–to-six weeks

REQUIRED Six–to-eight weeks Eight–to-twelve weeks

http://wyomingptsb.com/


Wyoming PTSB Application Form This form is required for EVERY application.

You must submit this form with your complete application packet or your application will not be processed.

Legal Questions Found on Page 7

I. APPLICANT INFORMATION (INK ONLY)

Social Security No. (Required)

- - Legal Last Name (Required) Legal First Name (Required) MI Maiden / Other Name

Address Date of Birth

Mailing Address:

/ /

City: State: Zip Code: Gender (Optional)

Male Female

E-Mail Address: Phone:

Primary: ( ) Work: ( )

Ethnicity (Optional)

American Indian or Alaska Native

Anglo, Caucasian, White, not of Hispanic origin

Asian, Japanese, Chinese, Vietnamese, Korean, Filipino

Black, African American, not of Hispanic origin

Hispanic, Chicano, Cuban, Puerto Rican, Latino, Mexican American

Native Hawaiian or other Pacific Islander

Please verify the following information:

Yes No Are you legally eligible to work in the United States?

Yes No Are you now, or have you ever been, a member of the United States military?

Yes

No

Are you currently employed as an educator in Wyoming? (Teacher, Substitute, Administrator, Related Services, or Coach)

District and School: ____________________________________________________________________________________

Subject(s) and Grade Level(s) (if applicable): __________________________________________________________________

II. LICENSING AND LEGAL INFORMATION

IMPORTANT: Failure to answer any of the licensing and legal questions in a truthful and complete manner or failure to provide truthful information or supporting documents could lead to your application being cancelled and fee forfeited. Failure to answer

could also lead to disciplinary action toward any PTSB license or permit you possess.

All conduct must be disclosed. Even if:

• It happened more than 10 years ago

• It happened in another state, federal court, tribal, military,

or jurisdiction outside the United States

• You did not go to court and your attorney went for you

• You did not go to jail or the sentence was only a fine or

probation

• You received a certificate of rehabilitation

Note: If your conviction was later dismissed, expunged,

set aside, or the sentence was suspended, you may be

required to provide court documentation verifying the final

disposition.

What to include in your personal statement:

• Detailed explanation of each question marked “yes” on

page 7

• Dates and locations

• Final disposition and/or what was done to resolve the

situation

• Documentation regarding:

o Disposition of arrest and/or conviction

o Any investigation or discipline on a professional

license

Below are examples of personal statements: Acceptable: “I was arrested for shoplifting in May of 1983. I was sentenced to pay restitution and received a fine of $300. I paid the restitution and fine and my case was closed. I contacted the court and was told my records are no longer available because the arrest happened over 30 years ago. The court provided me with the attached document which verifies that my records are no longer available.”

Applicant Signature Unacceptable: “I was convicted of a DUI in April 2003. Everything has been taken care of, and my case has been closed.”

Applicant Signature For more information, see the Licensing and Legal FAQs at http://wyomingptsb.com/frequently-asked-questions/faq-legal/

http://wyomingptsb.com/frequently-asked-questions/faq-legal/


II. LICENSING AND LEGAL QUESTIONS [Required]

BEFORE SIGNING, CHECK PAGES 6 AND 7 FOR COMPLETENESS:

Personal information with correct SSN, Mailing Address, Phone Number, E-Mail Address, and Date of Birth filled in on page 6

All Legal questions marked “yes” or “no” on page 7

Signed, detailed personal statement attached (if applicable)

Court documents (if applicable)

WARNING: Answers to the following questions are required. For each question that applies to you, you must answer “yes”, EVEN IF you have already answered “yes” in a previous application. Answering “yes” does not lead to the automatic denial of your application. If you answer “yes” to any question, you must submit a signed personal statement and supporting documents (if applicable) even if you have previously submitted a statement.

For more information on personal statements, see page 6

1 Yes

No

Have you ever had any license, permit, or certificate from ANY professional licensing authority (education, nursing, speech-language pathology, etc.) suspended, revoked, voided, canceled, denied, rescinded, rejected, and/or otherwise taken away in Wyoming, any other state, or elsewhere?

2 Yes

No

Is there any action or investigation pending against a license, permit, or certificate held by you from ANY professional licensing authority in Wyoming, any other state, or elsewhere?

3 Yes

No

Have you ever resigned, been disciplined, discharged, or asked to resign or retire from a professional position or military service because of allegations of misconduct, or is any such action pending?

IMPORTANT: This includes discipline for failure or refusal to fulfill an employment contract.

4 Yes

No

Have you ever been investigated, arrested, taken into custody, cited, charged, indicted, tried, pleaded guilty to, or convicted of a felony or misdemeanor, or been found to have committed a probation or parole violation? Exclude minor traffic violations such as infractions, parking tickets, and speeding tickets.

IMPORTANT: In responding to this question, include any pending investigation or charge. Include all cases from federal, state, local, tribal, and military tribunals. You must also include all cases that were settled or closed by a withheld judgement or through retained jurisdiction, etc., or handled through juvenile proceedings. Even if you pleaded nolo contendere (no contest) you must disclose this. DUI’s or careless driving tickets stemming from a DUI are NOT considered minor traffic violations and must be reported.

5 Yes

No

Is there any information not disclosed by your answers concerning your background, history, experience, education, or activities which may have some bearing on your character, moral fitness, or ability to hold a license, permit, or certificate in Wyoming and which should be placed at the disposal or brought to the attention of the Wyoming Professional Teaching Standards Board?

I attest and affirm that all statements made by me on this application are true and correct to the best of my knowledge. I understand that penalties, which may include revocation, suspension, denial, or refusal to renew, will be imposed under WS § 21-2-802 and PTSB Rules & Regulations, for making any false statement(s) on this application or required documents.

Applicant Printed Name _______________________________________________

Applicant Signature _______________________________________________ Date ______________________


III. INDIVIDUAL PERMIT REQUIREMENTS Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the

corresponding section.

Substitute Teacher Permit Application Fee: $50.00

Traditional Route

A Substitute Teacher Permit obtained in Wyoming is valid for five years. An individual who holds this permit is eligible to substitute teach in any Wyoming classroom, grades K-12.

Requirements: Check the box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

Official transcript(s) verifying completion of an Associate’s degree or sixty (60) semester hours from a regionally accredited institution. (see page 16)

Alternative Route

A Substitute Teacher Permit obtained in Wyoming is valid for five years. An individual who holds this permit is eligible to substitute teach in any Wyoming classroom, grades K-12.

Note: Applicants who have not earned an Associate’s degree or sixty (60) semester hours of college credit may choose to apply for a Wyoming Substitute Teacher permit through the Alternative Route. Contact your school district or BOCES to inquire if the district offers the Alternative Route.

Requirements: Check EACH box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

High School Diploma or High School Equivalency Certificate

24 total hours of in-service training – In-service training workshops are offered through individual Wyoming school districts. Districts or BOCES may authorize substitute teaching candidates to meet this requirement by taking PTSB-approved workshops. If the in-service training workshops listed below will not cover the required topics or be completed in a timely manner, please contact your school district for workshop dates.

30 Hours of classroom observation – The applicant must contact the school district directly and make arrangements with the district superintendent to complete the classroom observation required (10 hours must be completed at EACH level: elementary, junior high/middle, and high school).

Verification by the district or BOCES representative that the applicant has completed the required in-service training and the required classroom observation. The applicant must have the district or BOCES representative complete the following information:

As a representative of ____________________________________________________________________, I hereby verify that the

applicant, _________________________________________________, has completed all of the requirements listed below.

• 24 hours of in-service training to assure competency in (A) age level communication skills, (B) use and application of lesson plans, (C) use of instructional technology, and (D) professional attitude, behaviors, and dispositions; as well as

• 30 hours of classroom observation which must include at least 10 hours of observation at EACH of the grade levels (elementary, junior high/middle, high school).

District or BOCES Representative Signature ________________________________________________________ Date ___________________

Lifetime Substitute Teacher Permit Application Fee: $50.00

A Lifetime Substitute Teacher Permit never has to be renewed. An individual who holds this permit is eligible to substitute teach in any Wyoming classroom, grades K-12.

Note: A Lifetime substitute permit is only issued to a previously licensed educator who held a current and valid license at the time of retirement AND who has retired from the profession.

Requirements: Check the box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

Verification from the district office from which you retired indicating previous employment and date of retirement on district letterhead

Copy of out-of-state license that was valid at time of retirement from an out-of-state school district (out-of-state retirees only)


IV. INDIVIDUAL COACHING PERMIT REQUIREMENTS Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the


Head Coaching Permit Application Fee: $50.00

A Head Coaching Permit is valid for five years. An individual who holds this permit is eligible to coach ONLY the specific sport for which he/she holds a permit, but may be assigned as the Head or the Assistant Coach for that specific sport(s).

Note: If you DO NOT meet all requirements for the Head Coaching permit but you have been hired as a Head Coach, you may be eligible for a Transitional Coaching Permit. Refer to the Transitional Coaching Permit section of this application (see page 11).

Please indicate the sport-specific area(s) for the Head Coaching Permit for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Softball

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

All applicants for a Head Coaching Permit must meet the following requirements:

Requirements: Check EACH box below to indicate that you have met the requirement; then indicate how you met the requirement by checking the appropriate item under each requirement. Documentation for each requirement MUST be attached.

High School Diploma or High School Equivalency Certificate (if you currently hold a permit or license with PTSB, you do not need to resubmit this proof)

Current Hands-on or Hybrid 1st Aid/CPR Training – applicants must submit copies of current, valid (front and back if applicable) 1st Aid/CPR card(s)

OR an original, signed letter of verification in place of 1st Aid/CPR card(s) which must include: dates of the course(s), instructor’s contact information, and expiration date(s) of the 1st Aid/CPR certification(s).

This requirement has been met by (choose one):

Red Cross Wyoming Coaching Association/Foundation Clinic

American Heart Association

American Sport Education Program (ASEP)-Hybrid ONLY

National Federation of State High School Associations (NFHS)-Hybrid ONLY

Care and Prevention of Athletic Injuries (equivalent to 2 semester hours)


College Transcript Wyoming Coaching Association/Foundation Clinic

Professional Development (this course must be at least 21 hours long and be conducted by a certified instructor.)

Foundations of Coaching, Theory of Coaching, Fundamentals of Coaching, or Coaching Principles


College Transcript Wyoming Coaching Association/Foundation Clinic (Fundamentals of Coaching)

National Federation of State High School Associations (NFHS) (Fundamentals of Coaching)

American Sport Education Program (ASEP) (Coaching Principles)

Prior Coaching Experience or “Theory of Each Specific Sport”


Three (3) years of successful experience in each sport checked above as a coach, verified by supervisor on official school letterhead

Theory of Coaching the Specific Sport met by (choose one):

College Transcript American Sport Education Program (ASEP)

Wyoming Coaching Association/Foundation Clinic

Development and Psychology

This requirement has been met by:

A three (3) semester hour course in Lifespan-Human Development OR Developmental Psychology

Attention: If you have attended the Wyoming Coaching Association/Foundation Clinic documentation of the courses you completed are not needed. If you have taken other courses you feel meet any of these requirements please submit the course information for review.


IV. INDIVIDUAL COACHING PERMIT REQUIREMENTS continued Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the


Assistant Coaching Permit Application Fee: $50.00

An Assistant Coaching Permit is valid for five years. An individual who holds this permit is eligible to coach ONLY the specific sport for which he/she holds a permit.

Note: If you DO NOT meet all requirements for the Assistant Coaching permit but you have been hired as an Assistant Coach, you may be eligible for a Transitional Coaching Permit. Refer to the Transitional Coaching Permit section of this application (see page 11).

Please indicate the sport-specific area(s) for the Assistant Coaching Permit for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Softball

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

All applicants for an Assistant Coaching Permit must meet the following requirements:


High School Diploma or High School Equivalency Certificate (if you currently hold a permit or license with PTSB, you do not need to resubmit this proof)

Current Hands-on or Hybrid 1st Aid/CPR Training – applicants must submit copies of current, valid (front and back if applicable) 1st Aid/CPR card(s) OR an original, signed letter of verification in place of 1st Aid/CPR card(s) which must include: dates of the course(s), instructor’s contact information, and expiration date(s) of the 1st Aid/CPR certification(s).


Red Cross Wyoming Coaches Association/Foundation Clinic

American Heart Association

American Sport Education Program (ASEP)-Hybrid ONLY






Foundations of Coaching, Theory of Coaching, Fundamentals of Coaching, or Coaching Principles


College Transcript Wyoming Coaches Association/Foundation Clinic (Fundamentals of Coaching)

National Federation of State High School Associations (NFHS) (Fundamentals of Coaching)

American Sport Education Program (ASEP) (Coaching Principles)

Prior Coaching Experience or “Theory of Each Specific Sport”


One (1) year of successful experience in each sport checked above as a coach, verified by supervisor on official school letterhead

Theory of Coaching the Specific Sport met by (choose one):

College Transcript American Sport Education Program (ASEP)

Wyoming Coaches Association Clinic



III. INDIVIDUAL COACHING PERMIT REQUIREMENTS continued Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the


Transitional Coaching Permit Application Fee: $150.00

A Transitional Coaching Permit is valid for three years and is issued when a coaching applicant is unable to meet all of the requirements for a Head or Assistant Coaching Permit or endorsement on a standard teaching license. An individual who holds this permit is eligible to coach ONLY IN THE SPECIFIC POSITION for which he/she has been hired.

Note: The Transitional Coaching Permit is valid for three years from the date issued. NO extensions will be granted.

I am applying for:

Transitional Head Coaching

Please indicate the sport-specific area(s) for the Transitional Head Coaching Permit for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Softball

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

Transitional Assistant Coaching

Please indicate the sport-specific area(s) for the Transitional Assistant Coaching Permit for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Softball

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

All applicants for a Transitional Coaching Permit must meet ALL of the following requirements:


High School Diploma or High School Equivalency Certificate (If you currently hold a permit or license with PTSB, you do not need to resubmit this proof)

Verification of Employment Form(s) (see page 15), be filled out completely and accurately and submitted as part of the complete application packet.

Current Hands-on or Hybrid 1st Aid/CPR Training – applicants must submit copies of current, valid (front and back if applicable) 1st Aid/CPR card(s) OR an original, signed letter of verification in place of 1st Aid/CPR card(s) which must include: dates of the course(s), instructor’s contact information, and expiration date(s) of the 1st Aid/CPR certification(s).


Red Cross Wyoming Coaching Association/Foundation Clinic

American Heart Association American Sport Education Program (ASEP)-Hybrid ONLY


Applicants for Transitional Head Coaching must meet the following additional requirement:





Applicant Signature (All applicants for a Transitional Coaching Permit must sign below)

By signing below, I understand that I have up to three (3) years from the date my Transitional Coaching Permit is issued to complete all additional requirements in order to become fully endorsed as a Head or Assistant Coach. I understand that this permit is not renewable or extendable.

Applicant Printed Name _______________________________________________

Applicant Signature _______________________________________________ Date _____________________



III. INDIVIDUAL PERMIT REQUIREMENTS continued Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the


Internship Permit Application Fee: $50.00

An Internship Permit is valid for two years. An individual who holds this permit is eligible to serve in a specific assignment as an intern for a Wyoming school district. The applicant must make arrangements with a Wyoming school district for an available internship position.

Note: An Internship Permit is temporary and cannot be extended or renewed. The Internship Permit is required while performing in the role of an intern. The Wyoming school district will determine if the internship will be a paid or unpaid internship.

I am applying for an Internship Permit for:

School Counselor School Principal District Superintendent School Social Worker

School Psychologist Program Director/Coordinator/Supervisor Speech-Language Pathologist


Proof of enrollment from the institution of higher education stating acceptance into an internship program

Official transcript showing all current courses (see page 16)

Letter from an official school district representative verifying the internship assignment AND verifying the applicant will be supervised during the internship period

Professional, Industry, and Careers (PIC) Permit Application Fee: $100.00

A Professional, Industry, and Careers (PIC) Permit is valid for five years. An individual who holds this permit is eligible to teach grade levels 6-12 only in the field(s) of occupational specialty for which the applicant has met all the requirements.


Minimum of two (2) years work experience in the past five (5) years for EACH field of occupational specialty for which the applicant is seeking a PIC Permit.

Note: Exclude any educational/training experience.

Verification of Employment Form(s) (see page 15), for EACH field of occupational specialty for which the applicant is seeking a PIC Permit must be filled out completely and accurately and submitted as part of the complete application packet

o For self-employed applicants, please provide tax documentation

Current and valid license(s) in EACH of the applicant’s occupational specialties when one is required by state or federal statutes

Plan for Continued Professional Advancement

Please indicate the PIC area(s) for which you are applying:

High School Diploma, High School Equivalency Certificate, or higher is required for applicants seeking specified permit(s) listed below:

Architecture & Construction

Finance

Health Science

Hospitality & Tourism

Manufacturing

Transportation, Distribution, & Logistics

Education & Training

Arts, A/V Technology, & Communications

Government & Public Administration

Hospitality & Tourism

Human Services

Information Technology

Marketing, Sales, & Service

Law, Public Safety, Corrections, &

Security

Science, Technology, Engineering, &

Mathematics

Trade & Technical (formerly Industrial

Arts)

Bachelor’s degree or higher in the specific discipline is required for applicants specified permit(s) listed below:

Agriculture, Food, & National Resource Business, Management, & Administration Family and Consumer Science


III. INDIVIDUAL PERMIT REQUIREMENTS continued Please indicate which type of permit(s) you are applying for by checking the appropriate boxes and providing all information required in the


Educational Sign Language Interpreter (ESLI) Permit Application Fee: $50.00

The ESLI Permit is valid for five years. Effective June 11, 2011, all interpreters shall hold a permit to function in a Wyoming school district as an Educational Sign Language Interpreter (ESLI).


Submit an Institutional Recommendation (see page 14) and official transcripts (see page 16) with degree(s) listed from an accredited institution of higher education;

OR

Documentation of national certification;

OR

Obtain a score of 3.5 or greater on the Educational Interpreter Performance Assessment (EIPA) in one of the following areas of sign language: American Sign Language (ASL), Manually-Coded English (MCE), or Pidgin Sign Language (PSE);

OR

Documentation of successful, full-time experience as an interpreter in a public school setting three (3) out of the last six (6) years AND obtain a score of 3.2 or greater on the Educational Interpreter Performance Assessment (EIPA) in one of the following areas of sign language: American Sign Language (ASL), Manually-Coded English (MCE), or Pidgin Sign Language (PSE). To renew a permit issued under this requirement, the applicant shall obtain a score of 3.5 or greater on the EIPA in addition to all other standard renewal requirements.

Driver’s Education Permit Application Fee: $50.00

A Driver’s Education Permit is valid for five years. Per W.S. 21-7-303 (c) an individual is eligible to teach driver’s education in a Wyoming school district for three (3) years without an educator license or permit. Following the three (3) years of employment, a driver’s education teacher must hold a Wyoming Standard Educator License with the Driver’s Education endorsement or a Driver’s Education Permit. Requirements: Check EACH box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

Current and valid Wyoming driver’s license

High School Diploma or a High School Equivalency Certificate

Driver Education exam with a minimum passing score. (Applicants may call the Board Office at 307-777-7291 for testing directions and information.)

Native Language Permit Application Fee: $75.00

A Native Language Permit is valid for two years. An individual who holds this permit is eligible to teach the Arapahoe or Shoshoni language(s), grade levels K-12. Requirements: Check EACH box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

Written approval from the Tribal Council Committee

Verification of Employment form (see page 15) in a Native Language teaching position from the school district which has employed you.


INSTITUTIONAL RECOMMENDATION (ESLI Permit Only)

Reminder: YOU MUST INCLUDE AN OFFICIAL TRANSCRIPT THAT HAS YOUR DEGREE POSTED

Section I - Applicant’s Legal Name (Required) Social Security No. (Required)

-

-

Mailing Address

Street: City: State: Zip:

IMPORTANT! THE APPLICANT MAY NOT COMPLETE ANY PORTION OF SECTION II below. Section II is to be completed ONLY by the issuing institution’s official representative. Altering any information provided in Section II constitutes false representation and may be grounds for denial, suspension, or revocation of the applicant’s license.

Section II – College Representative: Please complete this section and return the original form to the applicant.

1

The above applicant is applying for an Educational Sign Language Interpreter Permit. Please complete the information below to verify the state approved professional education program completed by this applicant at your institution.

Degree: Completion Date:

Major or certification area:

2 Has the applicant met all state requirements to be eligible for licensure in the above listed endorsement area(s) in your state? If you answered NO, do not sign this form; return it to the applicant with a detailed explanation.

Yes

No

3 Is a test required for program completers to receive licensure in your state?

Name of test: ______________ Score required: __________

Date taken: _______________ Score required: __________

4 If you know of any reason this applicant should not serve in Wyoming schools, please send a separate statement to PTSB, 1920 Thomes Ave., Suite 100, Cheyenne, WY 82002.

5

If the applicant is not eligible for an institutional recommendation OR you are not a representative of an institution of higher education, please do not sign this form.

Print Name: _______________________________________________________________

Title: Ph: ( )

College: State:

Regionally accredited by:

Signature: Date:

Only the signature of a Dean of the College, Certification Officer, or designee can be accepted.

PLACE COLLEGE SEAL

HERE

(Application cannot be

processed without the seal)


VERIFICATION OF EMPLOYMENT (Transitional Coaching, Native Language, and PIC Applicants Only)

Applicant Information

Section I - Applicant’s Legal Name (Required) Social Security No. (Required)

-

-

Mailing Address


Telephone No. Email Address


Transitional Coaching Applicants: Please have a Wyoming school district representative complete Section II verifying current employment in an assistant or head coach position including the specific sport for which you have been hired.

Native Language Applicants: Please have a Wyoming school district representative complete Section II verifying current employment in a position teaching either the Shoshoni or Arapahoe language.

PIC Applicants: Please have your past or present employer(s) complete Section II. Applicants must provide verification of two (2) years of past employment experience in the past five (5) years for EACH field of occupational specialty for which the applicant is seeking a PIC Permit.

Authorized Signature Printed Name Title

Company Name or School District (Include District No.) Telephone No.

Primary: Work:

Mailing Address


I affirm that the information provided on this Verification of Employment is true and accurate to the best of my knowledge.

Signature Date

Section II – Verification of past or present employment. Employer please complete this section and return the original form to the applicant.

The above applicant is applying to the Wyoming Professional Teaching Standards Board for an Educator Permit and, as a requirement of his or her approval, must provide proof of past or present employment.

Transitional Coaching Applicants: This form should be completed by a Wyoming school district representative verifying current employment in an assistant or head coach position including the specific sport for which the applicant has been hired.

Native Language Applicants: This form should be completed by a Wyoming school district representative verifying current

employment in a position teaching either the Shoshoni or Arapahoe language.

PIC Applicants: This form should be completed by past or present applicable employer(s). The applicants must provide verification of two (2) years of employment experience in the past five (5) years for EACH field of occupational specialty for which the applicant is seeking a PIC Permit. Please complete this form below with dates of employment, what position was held by the applicant, and please attach a detailed description of the applicant’s work duties and responsibilities. For self-employed applicants, please complete the bottom portion of this form and attach tax documentation.

Note: Exclude any educational/training experience.

Dates of Employment Position Hired for or Held by Applicant

From: To:


VERIFICATION OF REQUESTED OFFICIAL TRANSCRIPTS For more information on submitting transcripts please visit:

http://wyomingptsb.com/licensure/becoming-licensed/official-transcripts/

Transcripts are required from ALL institutions attended.

Applicant’s Legal Name (Required) Social Security No. (Required)

-

-

Mailing Address


Telephone No. E-Mail Address


ATTENTION: If you were enrolled under a different name (first or last) while attending any of the colleges

or universities listed below, make sure to indicate it below or the application process will be delayed. Official Electronic Transcripts:

o Electronic transcript must be sent to PTSB directly from the college/university. Please have electronic transcripts emailed to [email protected].

Official Hard Copy Paper Transcripts:

o Official hard copy paper transcripts must be included with your paper application. Please DO NOT request the transcripts to be sent to PTSB separate from your complete application.

NOTE: If you submit official hard copy transcripts separate from your application packet or transcripts from ALL institutions attended are not received, your application will be considered incomplete, delaying the application process.

Date Requested Hard Copy Included

Electronic College/University Name Name while Attending

EX: 01/01/2017 University of Wyoming Mickey Mouse

http://wyomingptsb.com/licensure/becoming-licensed/official-transcripts/



VERIFICATION OF CONSTITUTION KNOWLEDGE http://wyomingptsb.com/licensure/us-and-wyoming-constitution/

Wyoming State Statute requires applicants to demonstrate knowledge of BOTH the U.S. and Wyoming Constitutions by college coursework or exam. Applicants who are reinstating a Wyoming license or permit have already met this requirement.

Applicant Information


-

-

Mailing Address


Demonstration of Knowledge through College Coursework

• Applicants demonstrating knowledge through college coursework must have a passing score of a “C” or better.

• Coursework for the U.S. Constitution requirement must cover U.S. history prior to 1865 and include the study of the U.S. Constitution. Political Science courses may be counted if they covered the Constitution.

• Coursework for the Wyoming Constitution requirement must cover Wyoming history and the Wyoming Constitution.

Please list the college coursework you have taken to meet these requirements below:

Course Prefix & Number Course Title

Institution Where Credit was Earned Final Grade

Year Course Completed

U.S.

WY

Demonstration of Knowledge through Exam

• Applicants demonstrating knowledge through an exam must receive a passing score of 75% or better.

• Exams may be taken at a Wyoming school district office or the Professional Teaching Standards Board office. Study guides for both exams are available online at http://wyomingptsb.com/licensure/us-and-wyoming-constitution.

• When taking either exam, the applicant must have the exam proctor complete the ”Proctor Information” section below.

Applicants Living Outside of Wyoming

• Applicants living outside of Wyoming may request to have the exam(s) proctored by a school administrator or college faculty member in the applicant’s state. Please email PTSB at [email protected] to request exams be sent directly to the proctor. Be sure to include which exam(s) are needed, the full name, and email address of the proctor in your request.

• Once the exams are completed, have the out-of-state proctor return the completed form and completed exams directly to you in a signed, sealed envelope so that you may submit the envelope as part of your complete application.

This section to be completed by the exam Proctor Wyoming proctors: Please add the exam scores where indicated and do not return the completed exam(s) to the applicant.

Out-of-state proctors: Once the exam(s) are completed, return this form along with the completed exam(s) in a signed, sealed envelope directly to the applicant so these items may be submitted as part of a complete application packet.

Proctor Information Printed Name Title

Company Name or School District (Include District No.) Telephone No.

Primary: Work:

Address


By signing below, I verify that the above applicant took the appropriate exam(s) as required.

Signature Date

This section for Wyoming Proctors only:

Exam Scores Received: U.S. Constitution ____________ Wyoming Constitution ____________

http://wyomingptsb.com/licensure/us-and-wyoming-constitution/

http://wyomingptsb.com/licensure/us-and-wyoming-constitution



PERMIT FEE PAYMENT FORM

Make fees payable to PTSB or Professional Teaching Standards Board Fees are payable by personal check, cash, money order, cashier’s check, or credit card. Checks must be written in black or dark blue ink only. Please be sure the applicant’s full name is written on the check.

Educator Permit Fee(s) $______________ Fingerprint Processing Fee (only if you DO NOT have a current license or permit from PTSB) $______________

Total Amount of Fees (ONE PAYMENT MAY BE SUBMITTED TO COVER ALL APPLICABLE FEES) $______________

Make fees payable to PTSB or Professional Teaching Standards Board and staple check (written in black or dark blue ink) or money order here or complete credit card information below:

(VISA, DISCOVER & MASTERCARD are accepted)


-

-

I AM MAKING PAYMENT BY CHECK, CASH, MONEY ORDER, OR CAHSIER’S CHECK. PTSB ID #:

I AM MAKING PAYMENT BY CREDIT CARD.

Cardholder Name (please print):

__________________________________

Cardholder Contact Number:

__________________________________

Cardholder Billing Address:

__________________________________ Street/PO Box

____________________________________ City State Zip

Visa MasterCard Discover

Credit Card Number:

- - - Expiration Date: CVC Code: (found on signature line, 3 to 4 digits)

-

_____________________________________________ Cardholder Signature Date

THIS PAGE WILL BE SHREDDED AFTER PAYMENT HAS BEEN PROCESSED.

Note: If you submit an incorrect fee, this will delay the processing of your application. Please contact our office if you have questions at (307) 777-7291.

**All Fees Are Processed Immediately and Are Non-Refundable**

Professional Teaching Standards Board 1920 Thomes Ave. Suite 100, Cheyenne, WY 82002

Fees

Substitute Teacher Permit (5 yr.) $50

Lifetime Substitute Teacher $50

Educational Sign Language Interpreter (5 yr.) $50

Driver’s Education (5 yr.) $50

Internship (2 yr.) $50

Head Coach (5 yr.) $50

Assistant Coach (5 yr.) $50

Transitional Coach (3 yr.) $150

Professional, Industry, & Career (PIC) (5 yr.) $100

Native Language (2 yr.) $75

Fingerprint Processing If you have a current PTSB permit or license, you do not have to submit fingerprint cards or pay the fingerprint fee.

$50

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