Fax

Vermont Department of Education,

Office of Educator Licensing



Educator Name and Address Change Form







Name and address change notification to the Licensing Office.



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In November the Office of Licensing sends out license renewal packets to educators whose

licenses expire on June 30.

The Licensing Office receives hundreds of renewals returned by the Post Office due to

incorrect names and/or addresses. These educators did not receive their renewal forms in a

timely fashion or, in some cases, did not receive them at all.

Again, we are asking for your assistance in notifying all Vermont educators that

November is name/addresses change notification month for the Licensing Office.



 Name & address changes must be received in writing by e-mail, fax,

US Mail or hand delivered to the Licensing Office.



 Fax and mail changes must include your SS#.



 Name & address changes cannot be accepted by telephone.



 Changes received after Wednesday, November 24th may result in delays in

receiving renewal forms to those whose licenses will expire next June.



 We will notify you that we received your faxed and e-mailed requests only if

you request that we respond.



 Renewal forms will be mailed out the last week of November.





E-mail address: Mailing Address:

licensinginfo@education.state.vt.us

Office of Educator Licensing

Fax: Vermont Department of Education

802-828-5107 120 State Street

Montpelier, VT 05620-2501

Vermont Department of Education

Office of Licensing and Professional Standards

120 State Street

Montpelier, VT 05620-2501

(802) 828-2445





Name/Address Change Form for License Renewals

Fax To: Office of Educator Licensing From:

Vermont Department of Education



Fax Number: (802) 828-5107

Date: ______________________________



Re: Name/Address Change



PRINT CLEARLY OR TYPE YOUR REQUEST, ESPECIALLY IF YOUR FORM WILL BE FAXED.



ILLEGIBLE CHANGE FORMS WILL BE RETURNED WITHOUT PROCESSING.



First Name on file: __________________________Last Name on file: ____________________________



Social Security # ________________ - ___________ - ___________________

(Changes cannot be made without SS#)



Any previous name(s) under which you may have been licensed in the past _______________________



_________________________________________ ____________________________________________







I authorize the Office of Educator Licensing to make the following changes on my permanent file.



Signed ____________________________________________ Date ___________________________





 Change my name to: ___________________ _________ ______________________

First MI Last Name





 Change my address to: ______________________________________________________



______________________________________________________



 Please send faxed notification that the Licensing Office received and made this change.



Fax my reply to this number. _______________________________

(We cannot send your confirmation without a fax number)