Free 53358.FH11 - Indiana

RECORD OF LICENSE CODING - RULES PRIOR TO 2002
State Form 53358 (9-07)

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RECORD OF LICENSE CODING
Name Action Social Security number *

Duplicate BASIS 1 2 3 4 Bulletin 94 Bulletin 192 Bulletin 400 Rules 46-47 VOID LICENSE

Renewal 1 2 3 4 5 7

Addition DEGREE None Associate Bachelor Master Specialist Doctorate

Conversion Professional Praxis 1 Reading Writing Math Praxis 2 Reading Specialty

Ten Year

Life Score

TEST VERIFICATION Cut-off 176 172 175 Code 370

Score

INTERNSHIP PROGRAM COLLEGE IR / AR - Required IC / AC - Completed IN / AN - Not required Blank

Gradation 5 6 7 8 9 Provisional Standard Professional OS I OS II 01 02 03 04 05 06

School Leaders 158 Licensure Assessment 165 (as of January 2005) Preparation Level - ALL OTHER RULES 07 08 19 09 10 11 All Grade Instructional Supervision Senior High / Junior High / Middle School School Services Personnel Administration / Supervision Occupational Specialist Grades

Early Childhood General Elementary Nursery School / Kindergarten Kindergarten / Primary Junior High / Middle School Secondary Competency

Subject Area

Comments

Signature of Licensing Advisor Name of Institution

Date signed (month, day, year)