Additional Licensure Review Form

Once you have been admitted to Bemidji State University, please complete the following Additional Licensure Review Form. This is the first of 4 checkpoints in the add-on licensure program.

Date

Name(Required)

First Last

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BSU Student ID (Tech ID)(Required)

You must be admitted to Bemidji State University prior to completing this application. To apply to BSU, visit the Admissions page. http://uh4.a6358.com/admissions/apply/

Which semester do you plan to start taking courses?(Required)

MN File Folder Number(Required)

If you do not know your MN license number, you can look it up on the PELSB (board of teaching) website: http://public.education.mn.gov/LicenseLookup/educator

Which add-on licensure area are you seeking?(Required)

You must have a full Minnesota Teaching License (Tier 3 or Tier 4) to add a field to your existing license.

Practicum Experience Verification Form (PEVF)

Max. file size: 8 MB.

If you having difficult uploading the file you can email it to the Clinicals Staff at: Teaching.Clinicals@a6358.com

Download a blank copy of the PEVF here.

If you would like to add any other information, please do so below.

Do you plan on seeking employment in a state or US territory OUTSIDE of Minnesota?

Yes

Please provide the state or territory in which you intend to seek employment.(Required)