1

LICENSE NUMBER

STATE OF WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION LICENSE

ISSUED

7
EXPIRES

I
JQHif #
POSITION GRADE OR SUBJECT

27 27

SECONDARY SCHOOL.TEACHER 'SECONOARV SCHOOL TEACHfift

7Qi, SkOAD FIELD SOCIAL S T U D I E S HISTORY

si B

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience and is licensed for the position, subject and/or grade herein listed.
IN WITNESS WHEREOF. I HAVE HEREUNTO AFFIXED MY SIGNATURE AND OFFICIAL SEAL AT THE CITY OF MADISON.

(/ A Life License issued a'tf j^'ie 3C 1952 Becomes invalid if. for 3 fwriod of live or rnore years, the lic actively employed in a pcs-^io^ -n me'teachmg profession I Pl-16C6(HEV 4-61.1
'

St*TE SUPERINTENDENT

STATE OF WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION LICENSE

LICENSE NUMBER ISSUED EXPIRES |

L55i

5 YEAR LICENSE JOHN W L E H M A N

POSITION

07/01/86

06/30/91 !

GRADE OR SUBJECT

27

SECONDARY SCHOOL TEACHER

405 COMPUTER SCIENCE

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparatioh and experience and is licensed for the position, subject and/or grade herein listed.
IN WITNESS WHEREOF, I HAVE HEREUNTO AFFIXED MY SIGNATURE AND OFFICIAL SEAL AT THE CITY OF MADISON.

STATE SUPERINTENDENT

Pl-!80 (REV 4(85)

STATE OF WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION "LICENSE

LICENSE NUMBEE IL55C

ISSUED

EXPIRES

7/1/1983

6/33/1*383

POSITION

GRADE OR SUBJECT

J! 27

SECONDARY SCHOOL TEACHER

405 COMPUTER SClfNCE

I 1
II

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience arid is licensed for the position, subject and/of grade herein listed.

I;

IN WITNESS WHEREOF. I HAVE HEREUNTO AFFIXED MY SIGNATURE AND OFFICIAL SEAL AT THE CITY OF MADISON.

{/ A Lite License issued site* June 30 1962 becomes invalid H, Ipr a period of five or more years, the licensee is not ;' * actively empicyeo ir. a posulion in me teaching profession ' : ,. ;.".,'- ." ' <-3l! ' ' . .' " . ' . . " . ^' - - . ' . . . 1

STATE SUPERINTENDENT

,:

-*f:-->" ' j - '

, >a? -HFl:

-'

/*:*
: '

STATE OF WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION LICENSE

LICENSENUMSER ISSUED EXPIRES

7/1/1983

6/30/1988

GRADE OH SUBJECT
I 27 SECONDARY SCHOOL T6ACHQC

CBMPWCR SCIENCE

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience and is licensed tor the position, subject and/or grade herein listed. ...
IN WITNESS WHEREOF. I HAVE HEREUNTO AFFIXED MY SIGNATURE AND OFFICIAL SEAL AT THE CtTY OF MADISON.

STATE SUPEBINTENOSNT

A tat L.ccn *fu,ta lut Junn SO, 1968 becomes invoud H (or i period pi live or mo< y**n. Ifi* hccnmo n not actively ernptoyM m i position m ih* leaching profession j
PI-1606 (tEV *-fn , , . ; -.. .',;^.^'-."? .,-' '.'.'< '.'.

%?"'.

STATE OF WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION LICENSE LICENSE NUU8EH ISSUED EXPIRES 6/JO/1983

15501

* 27 SECONDARY

POSITION

GRADE OR SUBJECT

SCHDOl.

COMPUTER SCIENCE

This is to certi^ that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience and is licensed for the position, subject and/or grade herein listed. ; > ; . , IN WITNESS WHEREOF.M HAVE HEREUNTO AFFIXED M SIGNATURE AND
'

A tile License iuud ilm June 30.1962 becomes myaiio il. lor a psnod ol livj of moft yews. Iht licensee o not actively emptoyeo n i pcamcn m the

PI-tCOB {REV. -ll

STATE OF WISCONSIN DEPARTMENT OF PUBUC INSTRUCTION LICENSE

ISSUED

07/01/86

POSITION

GRADE OF SUBJECT

27 27 21

SECONDARY SCHQGt SECONDARY SCHOO1. TGACHeR SECONDARY SCHOOL TACHR

StUDlcS

2?

SECONDARY

fiCONQMlCS

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience and Is licensed for the position, subject and/or grade herein listed.

IN WITNESS .WHEREOF, I HAVE HEREUNTO AFFIXED MY SIGNATURE AND QFFICIAL SEAL.AT;THE CCTY OF MADISON.

PI-1606 (REV J/85)

I

This is to certify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory, evidence of preparation and experience and is licensed for the position, subject and/or grade herein listed.
IN WITNESS WHEREOF.,.! .HAVE. HEREUNTO AFFDCED'MY- SIGNATURE AND '

If

StOt SUPWHNTENOEMT

PI-160S (REV 4/65)

State of Wisconsin Department of Public Instruction

Mailing Address: P.O. Box 7841, Madison, Wl 53707-7841 125 South Webster Street, Madison, Wl 53702 (608)266-3390 TDD (608) 267-2427 FAX (608) 267-1052 Internet Address: www.dpi.state.wi.us

eth *'iztabcSuperintendent State

DATE: TO: FROM:

January 11,2003 John Lehman Susan K. Smith, Licensing Consultant (608) 266-0452 (voice) (608) 264-9558 (fax) e-mail: susan.smith@dpi.state.wi.us File i

Enclosed is your emergency license for the 2002-03 school year. Renewal of this emergency license for the 2003-04 school year will be contingent upon a request for renewal from the district administrator or designated official of the school district and upon completion of six (6) semester credits in psychology (see attached). You need to submit verification of a total of 9 psychology credits for regular licensure. If you are eligible for a regular, five-year license by August 31, 2003, you would submit an initial application* to which you will attach official transcripts which verify 9 psychology credits. If you are not finished with all licensure requirements by August 31, 2003, we should receive your emergency renewal application** with an official transcript that verifies you completed 6 semester credits in psychology during the 2002-03 school year by September 1, 2003. Please feel free to contact me if you have any questions.
ss cc:

Resources Racine Unified School District

*Use attached application if you are eligible for the five-year license by August 31, 2003, ** Application form available on our web site: www.dpi.state.wi.us/dlsis/tel. The emergency application form is PI-1602-EL.

Rev. 8/21/02

Wisconsin Department of Public Instruction

FOR INFORMATION CONTACT Telephone No. Voice Mail No. FAX No. Web Site (606) 266-1027 1 -BOO-266-1027 (608) 264-9558 www.dpi.state.wi.us/dlsls/tel

LICENSE APPLICATIONEMERGENCY PERMIT OR SPECIAL

PI-1602-EL (New 01-02) Page 2A This form is available at www.dpi.state.wi.us/dlsis/tel/applications.html I. APPLICANT INFORMATION Legal Name First

Email Address Optional rea code) Current District of Employment lExt. Alternate Telephone (include area coda) ! Ext.

Most Recent Wisconsin Education License Not currently under district contract Issue Yeeg&OO 0 \ Expire Year II. WHICH EMERGENCY LICENSE ARE YOU REQUESTING?

Assignment Part A Check One Box Only C] Part Time D 3-Year Short-Term Substitute Permit Part B Select Permit or Special [H Permit (bachelor's degree, not licensed as a teacher) Official transcript confirming degree Name of Institution
** " """["" . .... i -.. --"?]"" "Ill I II II I I I ^ m . . ! . IH . ...!

Grade Levels

If part time, indicate percentage of school day

Long-term substitute

O Enclosed

U Mailed Separately Degree Date Mo/Day/Vr.

JS Special (licensed as a teacher in Wisconsin, but will be teaching out of field) Part C Applicant's Verification (Not Required for 3-Year Short-Term Substitute Permit) I UNDERSTAND that the issuance or denial of a special license or permit is at the discretion of the state superintendent. Renewal of this emergency license will be considered only if the employing administrator requests renewal of the license and satisfactorily explains the need, and if six semester credits in an approved program are satisfactorily completed between the emergency license Issuance date and the renewal date. Applicant Signatui Date Signed, MoJDay/Yr,

IQI m
III. INSTITUTIONAL VERIFICATION (for Emergency License Renewal Only) \, THE CERTIFYING OFFICER, CONFIRM that the applicant is enrolled in this institution's state-approved education program. Within the last year the applicant has completed at least six credits toward full licensure. Signature of Certifying Officer Date Signed Mo./Day/Yr, Name of Institution

Applicant must also complete and sign the attached Conduct and Competency Review Form (PI-1 6Q2-A) For DPI Use Only For Bank Use Only Amount of Remittance . Date Stamp OFF D Conduct

$100

Complete Section IV on next page to provide School District's request and justification.

Papa 2B
IV. SCHOOL DISTRICTS REQUEST School District Requesting Emergency License

PI-1602-EL

Racine Unified School District School District Address

2220 Northwestern Avenue, Racine, WI, 53404

_____ 2002 Indicate Year LEA Number 4620 CESA Number
#1

School District Telephone Area/No. (262) 631-7020 Requesting License for School Year Beginning July 1,

JUSTIFICATION FOR REQUEST (attach additional 8.5 x 11 sheet If needed) Check Only One:

C] 3-Year Short-Term Substitute Permit By signing this request you are confirming that your district has a shortage of fully licensed substitute teachers. You are also confirming that training for substitute teaching will be provided to the applicant, l Other (Emergency Permit, Special) Fully explain and justify the need for this request This justification is a determining factor in the issuance or denial of the request If fully licensed candidates are available, the request will be denied unless the justification clearly Indicates the specific reason each licensed applicant was not employed.

The Racine XJrtified School-D&tricthas. employed John Ldhman as a Social Studies teacher for the 2002-03sdiobl year. _^spart of his Social Studies assigrtmeqrtfc he will be teaehfcg one class of Psychology, JEylr. Lehrruan holdsajSoda^ am requesting;mathebe issued a j6ne-year special license for the Psychology position. The District advertised vacancies at college and university placement offices in and out of state as well as over the internet. In addition, the District did active on-campus recruiting for Social Studies/Psychology teachers and participated in college recruitment fairs in and out of state but to no avail. Mr. Lehman is aware of the requirements for a person working on a special license to enroll in a program leading to certification in the area. The completed application form and the $100 fee are enclosed with this request. Should you have questions/ please feel free to contact me.;

Name of Employing Administrator Print or type cfearfy. Steven Hejnal, Human Resources Director Signaturaj3i45nglo^ing A Date Signe

Department of public SnsttUct

LICENSE NUMBER ISSUED EXPIRES

L550000068179

1-year Special License JOHN W LEHMAN

29 SECONDARY LEVEL (GRADES 9-12) 7 4 PSYCHOLOGY .0
end of certificate -

7/1/2002

6/30/2003

This is to verify that the person named herein has furnished the State Superintendent of Public Instruction with satisfactory evidence of preparation and experience and is licensed for .the position, subject, and/or grade herein listed.
IN WITNESS WHEREOF, I HAVE HEREUNTO AFFIXED MY SIGNATURE AND OFFICIAL SEAL.

STATE SUPERINTENDENT

PI-1606Rev. 1/02