Fillable Digital COVID 19 Exception Authorization 04 22 2020

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Digital COVID 19 Exception Authorization 04 22 2020

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COVID-19
Exception Authorization
Application Packet
This Application Packet is for Individuals Applying for a
COVID-19 Exception Authorization
IMPORTANT: You must FIRST download this application to your computer before completing
the packet. Once downloaded, save the application in a destination on your computer you wish
by clicking File, then Save As, select your Save Destination, name your application, example:
“John Smith Permit Application”, then click Save. Please be sure to read ALL sections of the
application packet carefully before completing. Once you finish filling out the digital application
you will need to click Save again, then you may email your completed application to PTSB.
Submit your complete application packet via email to:
wyoptsb@wyo.gov
or
You may fax it to PTSB at (307) 777-8718
- 2 -
FORM_TEAL_EA Updated 04/22/2020
Application Instructions
Exception Authorization
Attention - Applicants who are granted an COVID-19 Exception Authorization will be responsible for
following through with all the requirements. The COVID-19 Exception Authorization is for applicants who
were unable to complete requirements to meet initial licensure, renewal, or reinstatement requirements due
to the novel coronavirus (COVID-19) pandemic. This Exception Authorization is valid for two (2) years and it
not renewable or extendable.
Tips for Applicants
• Before completing your application, read all instructions carefully .
• In order for PTSB to better serve you by processing your application quickly and efficiently, it is critical
that submitted application packets are complete and contain all supporting documentation as outlined
in the instructions and on the forms.
• PTSB would like you to email or fax your completed application to us.
• Application processing times vary throughout the year and depend upon whether an applicant is
required to submit fingerprints cards or not. Check our current processing time by visiting the PTSB
homepage: http://wyomingptsb.com.
• It is the applicant’s responsibility to maintain current information (including Name, Mailing Address,
Phone Number, and Email Address) on file w ith the Professional Teaching Sta ndards Board.
o To update your information please call our office at 307-777-7291.
Application Process
Step 1 — Complete the Wyoming PTSB Application Form
• Section I – APPLICANT INFORMATION (Page 6)
o Complete the information as outlined.
• Section II – LICENSING AND LEGAL INFORMATION (Pages 6 and 7)
o Please DO NOT include your Social Security Num ber on the forms. This is to protect
your identity. PTSB Staff will call y ou after receiving your application to get this
information from you.
o Please make sure you carefully read and complete pages 6 and 7 of the application.
o Any disclosure must be accompanied by a personal statement indicating the circumstances and
other related legal documentation (if applicable) to be considered complete. For more
information regarding your personal statement, see page 6.
o Failure to disclose will delay your application. This may also lead to a forfeiture of your fee and
denial, or cancelation of your application.
o If you have any questions regarding your particular circumstance(s), please contact our office at
307-777-7291.
o Sign and date the application (see bottom of page 7).
• Section III – INDIVIDUAL EXCEPTION AUTHORIZATION REQUIREMENTS
o Complete the box in this section w hich applies to the Exception Authorization option that applies
to your particular situation (see page 8) and gather any documentation required.
Step 2 — Complete fingerprint cards [if applicable]
• Applicants must provide fingerprints on two (2) original blue (FBI) fingerprint cards regardless of
how recent fingerprints were taken in another state or for any other purpose. Note: If you currently
hold a valid Wyoming license or permit through PTSB, you do not need to submit new fingerprint
cards.
• Applicants may obtain fingerprint cards and be fingerprinted by any law enforcement agency.
o If the local law enforcement agency will not provide two (2) blue (FBI) fingerprint cards,
applicants may email PTSB at wyoptsb@wyo.gov with applicant’s name and mailing address to
request cards.
• Include both blue fingerprint cards with your complete application packet.
• BEFORE submitting your fingerprint cards, be aware of the following conditions:
o Fingerprint cards MUST be completed in black ink only.
o Fingerprint cards MUST NOT be folded, stapled, or mutilated in any way.
• Fingerprint cards MUST NOT contain any smudged or unreadable prints.
- 3 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
Applicants who submit fingerprint cards not adhering to the above conditions may be requested by the
Wyoming Division of Criminal Inv estigation to send in a second set of fingerprint cards, delaying
their application.
Complete the following fields on BOTH of the BLUE (FBI) fingerprint cards:
Left Side
Applicant completes: Signature of Person Fingerprinted and Residence of
Person Fingerprinted
Official completes: Date and Signature of Official taking the Fingerprints
Middle
Column
Applicant completes: Last Name, First Name, Middle Name (top of card),
Aliases (if applicable), Citizenship, Social Security Number
Right side
Applicant completes: Sex, Race, Height, Weight, Eyes, Hair, Date of Birth, Place
of Birth
Step 3 – Demonstrate U.S. and Wyoming Constitution knowledge (Page 9)
[if applicable]
• If you currently hold or have ever held a license or permit through PTSB, you do not need to
demonstrate knowledge of the U.S. and Wyoming Constitutions again.
• Applicants are required to demonstrate knowledge of both the U.S. and Wyoming Constitutions
either through an exam or college course(s). Course(s) must be passed with a grade of a “C” or
better.
• If you have not completed a college course(s) to meet the U.S. and W yoming Constitution
requirements, you may demonstrate knowledge through an exam with a passing score. You may
request the exam by emailing wyoptsb@wyo.gov. These exams are graded automatically upon
submission and sent to PTSB.
• U.S. and Wyoming Constitution Study Guides are available at:
http://wyomingptsb.com/licensure/us-and-wyoming-constitution/
• Complete the Verification of Constitution Knowledge form by signifying that you completed the
online exam(s), or included official transcripts indicating course(s) that meet these requirements
with your complete application packet.
Step 4 - Payment
• Fee amounts are listed on page 4. Please note that if you do not currently hold a valid license or
permit through PTSB, be sure to include the $50 fingerprint processing fee.
• The fees may be paid by personal checks, cash, money orders, cashier’s check, and credit card.
o If you would like to pay with credit card, please check the box below and PTSB staff w ill contact
you for payment information over the phone once your application has been received.
I would like to pay by credit card.
o If you would like to pay with a check or money order, please make it payable to PTSB or
Professional Teaching Standards Board. Checks and money orders can be sent directly to PTSB
at:
Professional Teaching Standards Board
1920 Thomes Ave. Suite 100
Cheyenne, WY 82002
o Please DO NOT send cash in the mail. If you wish to pay with cash, please bring it to our office.
Exact amount only as we do not have change.
- 4 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
Step 5 — Submit your complete application packet to PTSB
• Your complete application packet should be submitted with the documents listed in the
checklist below:
Submit your complete application packet to:
wyoptsb@wyo.gov
or
You may fax it to PTSB at (307) 777-8718
WYOMING PTSB APPLICATION CHECKLIST
(Check the appropriate box next to EACH item included)
I have included two original blue (FBI) fingerprint cards [if
applicable] (see pages 2 and 3)
I have completed Sections I and II – Legal and Licensing
Information (see pages 6 and 7)
I have included a personal statement and court documents [if
applicable] (see pages 6 and 7)
I have completed Section III – Exception Authorization
Requirements (see page 8)
I have included the Verification of Constitution Knowledge form [if
applicable] (see page 9)
COVID-19 Exception Authorization
$100
Fingerprint Processing
Note: If you have a current PTSB permit or license, you do not have to submit fingerprint cards or pay the fingerprint fee.
$50
- 5 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
Step 6 — Monitor application status
• You may check the status of your application at any time by logging in to the PTSB w ebsite at
http://wyomingptsb.com.
How to check your status:
Step 1: Login to your account. If you do not already have an account, you will need to click
“register now” and create an account.
Step 2: Select “Educator Section: Click Here”
Step 3: Select “View Report of your Licensing Information”
Step 4: Underneath the applicant information section you will see the following:
• Estimated processing times:
These processing times are just estimates; they can be shorter or longer depending on
each individual situation.
Help Us Avoid Processing Delays
Our goal is to process your application and issue your Exception Authorization in a timely manner. To do
that, we ask that you submit your application packet with complete and accurate information. If an
application is received incomplete, you will receive a 30 Day Notice via email notifying you of your missing
requirements. If the missing items are not received within the 30 Days, your application may be canceled
and your fee may be forfeited.
Fingerprints
During the School Year
During the Summer Months
NOT REQUIRED
Two-to-four weeks
Four-to-six weeks
REQUIRED
Six-to-eight weeks
Eight-to-twelve weeks
- 6 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
Wyoming PTSB Application Form
This form is required for EVERY application.
You must submit this form with your complete application packet or your application will not be processed.
Legal Questions Found on Page 7
I. APPLICANT INFORMATION (INK ONLY)
Social Security No. (Required)
Legal Last Name (Required) Legal First Name (Required) MI
Maiden / Other Name
Address
Date of Birth
Mailing Address:
City: State: Zip Code:
Gender (Optional)
Male Female
E-Mail Address:
Phone:
Primary: Work:
Ethnicity
(Optional)
American Indian or Alaska Nativ e
Anglo, Caucasian, White, not of Hispanic origin
Asian, Japanese, Chinese, Vietnamese, Korean, Filipino
Black, African American, not of Hispanic origin
Hispanic, Chicano, Cuban, Puerto Rican, Latino, Mexican American
Nativ e Hawaiian or other Pacif ic Islander
Please verify the following information:
Yes
No
Are you legally eligible to w ork in the United States?
Yes
No
Are you now , or have you ever been, a member of the United States military?
Yes
No
Are you currently employed as an educator in Wyoming? (Teacher, Substitute, Administrator, Related Services, or Coach)
District and School: ____________________________________________________________________________________
Subject(s) and Grade Level(s) (if applicable): __________________________________________________________________
II. LICENSING AND LEGAL INFORMATION
IMPORTANT: Failure to answer any of the licensing and legal questions in a truthful and complete manner or failure to provide
truthful information or supporting documents could lead to cancellation of your application and forfeiture of your fee. Failure to
answer could also lead to disciplinary action toward any PTSB license or permit you possess.
All conduct must be disclosed. Even if:
• It happened more than 10 years ago
• It happened in another state, federal court, tribal, military,
or jurisdiction outside the United States
• You did not go to court and your attorney attended for you
• You did not go to jail or the sentence was only a fine or
probation
• You received a certificate of rehabilitation
Note: If your conviction was later dismissed, expunged,
set aside, or the sentence was suspended, you may be
required to provide court documentation verifying the final
disposition.
What to include in your personal statement:
• Detailed explanation of each question marked “yes” on
page 7
• Dates and locations
• Final disposition and/or what was done to resolve the
situation
• Documentation regarding:
• Disposition of arrest and/or conviction
• Any investigation or discipline on a professional
license
Below are examples of personal statements:
Acceptable:
“I was arrested for shoplifting in May of 1983. I was sentenced to pay restitution and received a fine of $300. I paid the restitution and
fine and my case was closed. I contacted the court and was told my records are no longer available because the arrest happened over
30 years ago. The court provided me with the attached document which verifies that my records are no longer available.”
Applicant Signature
Unacceptable:
“I was convicted of a DUI in April 2003. Everything has been taken care of, and my case has been closed.”
Applicant Signature
For more information, see the Licensing and Legal FAQs at http://wyomingptsb.com/frequently-asked-questions/faq-legal/
- 7 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
II. LICENSING AND LEGAL QUESTIONS [Required]
BEFORE SIGNING, CHECK PAGES 6 AND 7 FOR COMPLETENESS:
Personal information with correct SSN, Mailing Address, Phone Number, E-Mail Address, and Date of Birth filled in on page 6
All legal questions marked “yes” or “no” on page 7
Signed, detailed personal statement attached (if applicable)
Court documents (if applicable)
III. INDIVIDUAL LICENSURE REQUIREMENTS [Required]
WARNING: Answers to the following questions are required. For each question that applies to you, you must
answer “yes”, EVEN IF you have already answered “yes” in a previous application. Answering “yes” does not
lead to the automatic denial of your application. If you answer “yes” to any question, you must submit a signed
personal statement and supporting documents (if applicable) even if you have previously submitted a statement.
For more information on personal statements, see page 6
1
Yes
No
Have you ever had any license, permit, or certificate from ANY professional licensing authority (education,
nursing, speech-language pathology, etc.) suspended, revoked, voided, canceled, denied, rescinded,
rejected, and/or otherwise taken away in Wyoming, any other state, or elsewhere?
2
Yes
No
Is there any action or investigation pending against a license, permit, or certificate held by you from ANY
professional licensing authority in Wyoming, any other state, or elsewhere?
3
Yes
No
Have you ever resigned, been disciplined, discharged, or asked to resign or retire from a professional position
or military service because of allegations of misconduct, or is any such action pending?
IMPORTANT: This includes discipline for failure or refusal to fulfill an employment contract.
4
Yes
No
Have you ever been investigated, arrested, taken into custody, cited, charged, indicted, tried, pleaded guilty to,
or convicted of a felony or misdemeanor, or been found to have committed a probation or parole violation?
Exclude minor traffic violations such as infractions, parking tickets, and speeding tickets.
IMPORTANT: In responding to this question, include any pending investigation or charge. Include all cases
from federal, state, local, tribal, and military tribunals. You must also include all cases that were settled or
closed by a withheld judgement or through retained jurisdiction, etc., or handled through juvenile proceedings.
Even if you pleaded nolo contendere (no contest) you must disclose this. DUI’s or careless driving tickets
stemming from a DUI are NOT considered minor traffic violations and must be reported.
5
Yes
No
Is there any information not disclosed by your answers concerning your background, history, experience,
education, or activities which may have some bearing on your character, moral fitness or ability to hold a
license, permit, or certificate in Wyoming and which should be placed at the disposal or brought to the attention
of the Wyoming Professional Teaching Standards Board?
I attest and affirm that all statements made by me on this application are true and correct to the best of my knowledge.
I understand that penalties, which may include revocation, suspension, denial, or refusal to renew, will be imposed under WS § 21-2-
802 and PTSB Rules & Regulations, for making any false statement(s) on this application or required documents.
Applicant Printed Name _______________________________________________
Applicant Signature _______________________________________________ Date ______________________
- 8 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
III. INDIVIDUAL EXCEPTION AUTHORIZATION REQUIREMENTS
COVID-19 Exception Authorization
This type of Exception Authorization is for applicants who were unable to complete the requirements to meet initial
licensure, renewal, or reinstatement requirements due to the novel coronavirus (COVID-19) pandemic.
An Exception Authorization under these circumstances is valid for two-years and is non-renewable.
NO extensions will be granted.
Requirements: Check EACH box below to indicate that you have met the requirement. Documentation for each
requirement MUST be attached.
Written narrative outlining how the COVID-19 pandemic interfered with the completion of licensure, renewal, or
reinstatement requirements. The narrative shall include:
• What requirement(s) that were not met.
• The reason(s) why the COVID-19 pandemic interfered with, or influenced, the completion of the
requirements.
• A plan and projected timeline for completion for the requirements.
- 9 -
FORM_TEAL_COVID-19 EA Updated 04/22/2020
VERIFICATION OF CONSTITUTION KNOWLEDGE
http://wyomingptsb.com/licensure/us-and-wyoming-constitution/
Wyoming State Statute requires applicants to demonstrate knowledge of BOTH the U.S. and Wyoming Constitutions
by college coursework or exam. Applicants who are reinstating a Wyoming license or permit have already met this
requirement and are NOT required to meet this requirement again.
Applicant Information
Applicant’s Legal Name (Required)
Social Security No. (Required)
Mailing Address
Street: City: State: Zip:
Demonstration of Knowledge through College Coursework
• Applicants demonstrating knowledge through college coursework must have a passing score of a “C” or better.
o Coursework for the U.S. Constitution requirement must cover U.S. history prior to 1865 and include the study
of the U.S. Constitution. Political Science courses may be counted if they covered the Constitution.
o Coursework for the Wyoming Constitution requirement must cover Wyoming history and the Wyoming
Constitution.
Please list the college coursework you have taken to meet these requirements below:
Course Prefix
& Number
Course Title
Institution where Credit
was Earned
Final
Grade
Year Course
Completed
U.S.
WY
Demonstration of Knowledge through Exam
• Applicants demonstrating knowledge through an exam must receive a passing score of 75% or better.
• Applicants will need to send a request for the exam(s) to wyoptsb@wyo.gov. Please note that these exams are
graded automatically upon completion and sent to PTSB.
• Study guides for both exams are available online at http://wyomingptsb.com/licensure/us-and-wyoming-
constitution.
• Once you have completed the exam(s), please check the box below to notate that you have completed the
exam(s) online:
I have completed the online exam(s) and the results should be on file with PTSB.
For PTSB Use only
Exam Scores Received: U.S. Constitution ____________ Wyoming Constitution ____________
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Digital COVID 19 Exception Authorization 04 22 2020

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Completed 16 July 2020

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