ADE Director's Communication Memo Form

Memo Number : LIC-06-009

Date Created : 09/26/2005


Co-op Directors
other: All Principals; Teacher Center Coordinators

Type of Memo: Informational
Response Required: No
Section:   Human Resources/Licensure - Beverly A. Williams, Assistant Commissioner
Reporting Form for Act 1623 Waivers

Regulatory Authority:

Contact Person:
Ron Tolson

Phone Number:


The Professional Licensure Unit has created a standardized form for reporting the necessary information needed when making a waiver request(s) under Act 1623 of 2001. Please see attachment.  

This information will also be maintained at the ADE website and may be found there by clicking on Teachers, clicking on Licensure and scrolling down to just below Teacher Application.

Please use this form whenever submitting a waiver request (s) under Act 1623 of 2001.

Please address any questions regarding a waiver request(s) made under the requirements for Act 1623 of 2001, to Ron Tolson, Coordinator, Professional Licensure at 501-682-4342 or by e-mail at 


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