Adjunct Teacher Reporting

Created for Risa Regnier by Nhan Nguyen on 07/22/2022
Adjunct Teacher Reporting

An adjunct permit holder must create a profile in the online licensing system called LVIS. https://license.doe.in.gov/
Name of employing school corporation *
Corporation number (optional)
Name of person completing the form*

First NameLast Name
Email of person completing the form*

Confirmation Emailexample@example.com
Name of adjunct teacher/permit holder*

First NameLast Name
Permit holder’s SPN*
After verifying that the permit holder does not already have an SPN, the school employer must request an SPN: https://appcenter.doe.in.gov/. See helpful links here: https://www.in.gov/doe/it/data-reporting-help.
Subject area(s) of permit *
(may be multiple subjects)
Grade level(s) of permit (check all that apply)*

P-KK123456789101112
Summary of work experience on which the permit is based *
4 year minimum
Start date of employment agreement *

MonthDayYear
Date
End date of employment agreement*

MonthDayYear
Date
Total salary and other paid compensation (i.e., benefits) *
Is permit holder teaching?*

Part timeFull time
Education level completed by adjunct permit holder:*

high school diplomaone-year technical certificatesome collegeassociate degreebachelor’s degreegraduate degree
Number of previous adjunct employment agreements in the responding school corporation*

0123more than 3
Number of previous adjunct employment agreements in other school corporations*

0123more than 3
Should be Empty: