Www.doe.nv.gov license@doe.nv.gov State of Nevada ...

Las Vegas Office

2080 E. Flamingo Road Suite 210 Las Vegas, Nevada 89119 702-486-6458

Carson City Office 700 E. Fifth Street Carson City, NV 89701 775-687-9115

Emergency Substitute Request Requesting District Information (Completed by district) School District: ________________________________________________________________________ Address: City: _________________________________________________ State: _____ Zip: _________ Contact Name: ___________________________________ Phone Number: _______________________ We are requesting that the following individual be licensed to serve as an emergency substitute teacher pursuant to Regulation 028-21 adopted on February 28, 2022 amending NAC 391.0896: Applicant Information (Completed by applicant) Your signature below confirms that you have read and meet the requirements for an Emergency Substitute license found on our website: Name as it appears on your government-issued ID: __________________________________________ Date of Birth: _______________ Applicant Signature: ________________________________________ This is not an application for licensure. To obtain a license as an Emergency Substitute, the individual named above must complete and submit an application through OPAL, our online licensure system, with this completed and signed form.

NAC 391.0896 ? Endorsement as an Emergency Substitute Teacher To receive an endorsement as an emergency substitute teacher, a person must earn a high school diploma or its equivalent. An endorsement as an emergency substitute is valid for one (1) year after the date of issuance. A school district may, in an emergency, hire an emergency substitute teacher to serve as a teacher in PK through grade 12, as needed. Upon the written request of a school district, the Department may, in an emergency, authorize the district to hire an emergency. Per NAC 391.0896, I the superintendent named below am requesting licensure for the applicant as an emergency substitute. Requesting Superintendent (or Designee): Printed Name: ________________________________ Title: ___________________________________ Signature: ____________________________________ Date: __________________________________

Rev: 03/04/2022

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