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​Please complete the following form.  The content will be reviewed and verified by the Illinois State Board of Education.  It will be displayed in the registry when it is approved.​  ISBE reserves the right to edit any information that is not related to the types of evaluations to be performed.
Select an option from one of the following:  
License Information:  (Select a category from the dropdown. Enter the appropriate licensing information. To remove a category, click the "Clear Row" button.)
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Additional Certification Information:  (You can add up to 5 certifications. To remove a certification, click the "Clear Row" button.)
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Work Address:  You can enter up to 3 different work addresses, if you choose.
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Email:  You can enter up to 2 different email addresses, if you choose.
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Image:

Below is the image that will be used with your profile. If you would like to change this image, please send your image (.jpg, .jpeg, .png, .tif, .bmp, or .gif) via email to llane@isbe.net.

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If you would like to add an image to your registry entry, please send your image (.jpg, .jpeg, .png, .tif, .bmp, or .gif) via email to llane@isbe.net.

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