LICENSE UPDATE
Type or print the following information.
(See instructions on reverse side.)
last name first name middle name maiden
street address
city
state
zip code
social security number *
telephone number (with area code)
LEA and unit number (if employed in NC)
See instructions
Check the action you are requesting
change name
name as it now appears on the license
delete an area of licensure
area to be deleted (name and code)
change social security number
SSN as it now appears on the license
renew license
clear a provisional area
area to be cleared
validate an expired license
school year
other
Superintendent or Designee email address
Date
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STATEMENT OF APPLICANT
Have you ever had a certificate or license revoked or suspended by any state or other governing body? If yes, attach a statement giving full details and official documentation of the action taken. Have you ever been convicted of a crime (excluding minor traffic violations)? If yes, you must submit court documents that indicate judgment and disposition of the case from the court of conviction and an explanation of the incident(s). yes yes no no
I certify that the information provided in this application is correct and true. I understand that the falsification of any statement or document will result in the revocation of my North Carolina license. Signature Date
Email Address
Public Schools of North Carolina Department of Public Instruction Licensure Section 6365 Mail Service Center Raleigh, North Carolina 27699-6365 Form U August 2008
Form U: Instructions
This License Update is used for many purposes and by the LEAs. Some items may not apply to you. change in social security number clearance of a provisional area added by a Licensure Section evaluation deletion of an area of licensure name change renewal of a license validation of an expired license (Validations can be requested only by an employing school system, not by individuals.) Otherupgrade to higher level or additional license area
Follow these instructions for completing this form: Fill in current personal information (please print or type). SSN is required. It is your license number. *You are not required by law to disclose your social security number (SSN). However, your SSN is required by the North Carolina Department of Public Instruction (NCDPI) for purposes of issuing a NC teaching license. The NCDPI will not grant a teaching license without a valid SSN. Identify the North Carolina school system where you are employed (if applicable). Check the block(s) that corresponds to the desired action, and fill in the requested information. Signature of the superintendent or designee is not needed for a university recommendation. Answer the questions under Statement of Applicant only for license renewals. Sign and date the application. Include Email Address other than your ECU email.
Collect the necessary supporting materials for the request: change in social security number: Form U. No documentation or fee is required if an error was made by the Licensure Section or if the applicant is employed in a North Carolina school system. If the error is the applicants and the applicant is not employed by a North Carolina school system, a processing fee ($30) and a copy of the social security card must be submitted. clearance of a provisional area added by a Licensure Section evaluation: Original transcripts and Praxis scores (if a test or subject assessment was required). Note: Grade reports are not accepted in place of transcripts. ONLY Graduate Non-Degree students need to request a transcript, as noted on website. name change: Copy of court order if name was changed by legal action and a $30.00 processing fee is required to change a name. Copy of social security card, drivers license or marriage license is required if a name change results from marriage. Do not request a name change unless the change results from marriage or legal action. As long as you are paying the $55 fee for your updated license, the additional $30 is not required. ***************** DEGREE SEEKING STUDENTS Mail the completed application (2) forms, supporting materials, and one $55 fee, if applicable to East Carolina University, Teacher Education, Speight 105, Greenville, NC 27858 ***************** NON-DEGREE/POST BACH STUDENTS Submit completed application including your transcript and any other supporting materials to your departmental advisor. You may pay by personal check, money order, or certified check (made payable to the Department of Public Instruction), Visa or MasterCard. If you wish to pay by credit card, fill out the credit card payment form http://www.ncpublicschools.org/docs/licensure/ccform.pdf and include with forms. Please do not fold down the corners of pages or use staples or paper clips to secure the application materials. Doing so will slow down the automated application process and delay your response. Mail the unfolded materials in a 9" x 12" envelope. Thank you.
