Illinois State Board of Education
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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:
Send confirmation email.
Send removal email.
Name (Select your name from the dropdown.) (Enter your name as you would like it to appear in the registry.)
Name field is required.
Please select an evaluator from the list.
A removal reason is required.
Enter new legal name if applicable.
License Information (Select a category from the dropdown. Enter the appropriate licensing information. To remove a category, click the "Clear Row" button. )
At least one valid license category is required.
License Verified Category ISBE License # ISBE Expiration Date IDFPR License # IDFPR Expiration Date
Please enter a valid ISBE expiration date.
Please enter a valid IDFPR expiration date.
Please enter a valid ISBE expiration date.
Please enter a valid IDFPR expiration date.
Please enter a valid ISBE expiration date for Row 3.
Please enter a valid IDFPR expiration date for Row 3.
Please enter a valid ISBE expiration date for Row 4.
Please enter a valid IDFPR expiration date for Row 4.
Please enter a valid ISBE expiration date for Row 5.
Please enter a valid IDFPR expiration date for Row 5.
Additional Certification Information (You can add up to 5 certifications. To remove a certification, click the "Clear Row" button.)
Cert Verified Certification Name Credentialing Body Certification Number Expiration Date
Work Address (You can enter up to 3 different work addresses, if you choose.)
Primary work address is required.
Phone Numbers (You can enter up to 3 different phone numbers, if you choose.)
Primary phone number and type are required fields.
Email Addresses (You can enter up to 2 different email addresses, if you choose.)
Primary email address is required.
Foreign Language(s) (Check all that apply)
Region(s) (Check all that apply)
Click to view region map
ISBE reserves the right to edit any information that is not related to the types of evaluations to be performed.
Qualifications information is required.
ISBE reserves the right to edit any information that is not related to the types of evaluations to be performed.
Experience description is required.

Profile 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 .

Current profile picture for registry evaluator {{Request.Title}}

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 .

If the evaluator sent an image, please forward to Lori.
Approval:
Send approval email.
Send denial email.
Enter internal administrative logs or notes here.

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