Sign Legal Consultant

Fee

KSDE USE ONLY

Teacher Licensure and Accreditation - Kansas State Department of Education Expire FP In

24 P PROGRESS REPORT FOR KANSAS

FORM

RAP Sendback

M&E Verified by

LIMITED APPRENTICE LICENSE Walk-in

P RO G R ES S R EP O R T TO BE SU BMIT TED UPO N CO M PLE TIO N O F 1 S T SEM ESTER R EQ U I R E M E N TS

S E C T I O N A: TO B E CO M P L E T E D BY T H E A P P L I C A N T

Last 4 digits of Social Security Number: ________________________________________

9702
LEGAL NAME: First Name Middle Name Last Name
Melissa
________________________________________
Ruth
________________________________________
Reed
________________________________________

I have completed required 1st semester coursework from my plan of study.

CHOOSE ONE:
✔ I am including official paper transcripts with my progress report (No photocopies).
OR
My college/university submitted electronic transcripts directly to the following email address: etranscripts@ksde.org

I am enrolled in additional coursework from my plan of study.

Attach verification of enrollment.

SIGNATURE AND DATE REQUIRED

I certify that I am of good moral character and that the information on this application is true and complete to the best of my knowledge.  I understand
that any misrepresentation of facts may result in the denial or revocation of my certificate or license.

I hereby grant the permission and authorize the Kansas State Department of Education to verify all responses with any mental health facility or
governmental agency including a release of any information concerning myself in the child abuse and neglect central registry records, and to obtain
and review all records maintained by any criminal justice agency, including a criminal history record information check, regarding any of my criminal
charges, adjudications, or convictions, and to contact previous employers for information regarding the term of my employment.  I hereby release,
discharge, and exonerate the Kansas State Department of Education, its employees, and any person so furnishing information from any and all liability
of every nature and kind arising out of the furnishing of such records and information. I understand that any material submitted in connection with this
application will become the property of the Kansas State Department of Education, and may be considered a public record. 

AND
 
I hereby give my employing school district and verifying licensing institution permission to release any and all information needed.

Applicant Printed Name Last 4 digits of Social Security Number

Melissa Ruth Reed
________________________________________________________________________ _____________________________________________
9702

Signature of Applicant Date

________________________________________________________________________
7/30/2021
_____________________________________________

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SEND ORIGINAL SIGNED FORM 24P - NO PHOTOCOPIES ACCEPTED

APPLICANT CHECKLIST

COMPLETE FOLLOWING SECTIONS:

ALL THREE SECTIONS of the completed progress report must be mailed together.

1. SECTION A: APPLICANT - filled out completely and signed

2. SECTION B: DISTRICT - filled out completely by district and signed

3. SECTION C: UNIVERSITY - filled out completely by university and signed

4. MAIL ALL SECTIONS TO:

Teacher Licensure and Accreditation

KSDE
Landon State Office Building
900 S.W. Jackson Street, Suite 106
Topeka KS 66612-1212

2 of 10 TEACHER LICENSURE AND ACCREDITATION - KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org 01-10-2019
 Sign Legal Consultant

Fee

KSDE USE ONLY

Teacher Licensure and Accreditation - Kansas State Department of Education Expire FP In

24 P PROGRESS REPORT FOR KANSAS

FORM

RAP Sendback

M&E Verified by

LIMITED APPRENTICE LICENSE Walk-in

P RO G R ES S R EP O R T TO BE SU BMIT TED UPO N CO M PLE TIO N O F 1 S T SEM ESTER R EQ U I R E M E N TS

B: TO B E CO M P L E T E D BY D I S T R I C T
Last 4 digits of Social Security Number: ________________________________________
9702
LEGAL NAME: First Name Middle Name Last Name
Melissa
________________________________________ Ruth
________________________________________ Reed
________________________________________

SCHOOL DISTRICT:
yy Please complete and sign.
yy Return the completed, signed hard copy in a sealed official school envelope to the Applicant. Coordinate submission with the applicant.
Name of School System
______________________________________________________________________________________________________________________________
Name of School/District Administrator Title/Position Phone
________________________________________ ________________________________________ ________________________________________
Mailing Address
______________________________________________________________________________________________________________________________
City State Zip
________________________________________ ________________________________________ ________________________________________

ASSURANCES
I verify that:

The above applicant has completed all 1st semester requirements, including the required field experience (if in an elementary program)
and the required 1st semester coursework from the plan of study.
The applicant is currently enrolled in additional coursework from their plan of study and is on track to complete the program
requirements during the allowed two years of the program.

We continue to support this candidate and to collaborate with

(University Name)

regarding the approved program that the applicant will pursue and the on-site support the applicant will receive.

The applicant has been hired in the following assignment.

ASSIGNMENT (STATE COURSE CODE) GRADE LEVELS OF ASSIGNMENT

________________________________________________ ________________________________________________

________________________________________________ ________________________________________________

A Licensed teacher with a minimum or three years of experience is assigned as a mentor, and an approved mentor program will be
delivered to the teacher during the Apprentice License.
Name of Mentor Mentor ID #

___________________________________________________________ _____________________________________________

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I certify that the information on the application is true and complete to the best of my knowledge.

District Level Administrator Name (please print) Position Title (please print)

__________________________________________________________ __________________________________________________

District Level Administrator Signature Date

__________________________________________________________ __________________________________________________

The Kansas State Department of Education does not discriminate on the basis of race, color, national origin, sex,
disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated Teacher Licensure and Accreditation - Kansas State Department of Education (785) 296-2288
youth groups. The following person has been designated to handle inquiries regarding the nondiscrimination policies: Landon State Office Building, 900 S.W. Jackson Street, Suite 106
KSDE General Counsel, Office of General Counsel, KSDE, Landon State Office Building, 900 S.W. Jackson, Suite 102, Topeka, Topeka, KS 66612-1212 (785) 296-7933 - fax
KS 66612, (785) 296-3204

4 of 10 TEACHER LICENSURE AND ACCREDITATION - KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org 01-10-2019
 Sign Legal Consultant

Fee

KSDE USE ONLY

Teacher Licensure and Accreditation - Kansas State Department of Education Expire FP In

24 P PROGRESS REPORT FOR KANSAS

FORM

RAP Sendback

M&E Verified by

LIMITED APPRENTICE LICENSE Walk-in

P RO G R ES S R EP O R T TO BE SU BMIT TED UPO N CO M PLE TIO N O F 1 S T SEM ESTER R EQ U I R E M E N TS

C: TO B E CO M P L E T E D BY I N S T I T U T I O N
9702
Last 4 digits of Social Security Number: ________________________________________
LEGAL NAME: First Name Middle Name Last Name
Melissa
________________________________________ Ruth
________________________________________ Reed
________________________________________

INSTITUTION
yy Please complete and sign.
yy Return the completed, signed hard copy in a sealed official school envelope to the Applicant. Coordinate submission with the applicant.
Name of Institution
______________________________________________________________________________________________________________________________
Name of Program Administrator Title/Position Phone
________________________________________ ________________________________________ ________________________________________
Mailing Address
______________________________________________________________________________________________________________________________
City State Zip
________________________________________ ________________________________________ ________________________________________

ASSURANCES
I verify that:

The above applicant has completed all 1st semester requirements, including the required field experience (if in an elementary program)

AND
all required 1st semester coursework from the plan of study.
The applicant is ready to be assigned as a teacher based on observations during field experiences and success in coursework.
The applicant is currently enrolled in additional coursework from their plan of study and is on track to complete the program
requirements during the allowed two years of the program.

We continue to support this candidate and to collaborate with

(District Name and USD)

regarding the approved program and the on-site support the teacher will receive from our university.

I certify that the information on the application is true and complete to the best of my knowledge.

Program Administrator Name (please print) Position Title (please print)

__________________________________________________________ __________________________________________________

Program Administrator Signature Date

__________________________________________________________ __________________________________________________

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THIS PAGE INTENTIONALLY LEFT BLANK FOR PRINTING PURPOSES

The Kansas State Department of Education does not discriminate on the basis of race, color, national origin, sex,
disability or age in its programs and activities and provides equal access to the Boy Scouts and other designated Teacher Licensure and Accreditation - Kansas State Department of Education (785) 296-2288
youth groups. The following person has been designated to handle inquiries regarding the nondiscrimination policies: Landon State Office Building, 900 S.W. Jackson Street, Suite 106
KSDE General Counsel, Office of General Counsel, KSDE, Landon State Office Building, 900 S.W. Jackson, Suite 102, Topeka, Topeka, KS 66612-1212 (785) 296-7933 - fax
KS 66612, (785) 296-3204

6 of 10 TEACHER LICENSURE AND ACCREDITATION - KANSAS STATE DEPARTMENT OF EDUCATION | www.ksde.org 01-10-2019