Wisconsin Department of Public Instruction
1-YEAR ADMINISTRATOR LICENSE
PI-1602-AD1 (Rev. 12-06)
This form is available at: http://dpi.wi.gov/tepdl/applications.html
FOR INFORMATION CONTACT:
Telephone No. (608) 266-1027
Voice Mail No. 1-800-266-1027
Web Site http://dpi.wi.gov/tepdl
We do not accept applications by FAX.
WE WANT TO DO AN EXCELLENT JOB FOR YOU. HERE IS HOW YOU CAN HELP.
Use this PI-1602-AD1 application only if you are applying for or renewing a 1-year administrator license. The license is requested by
an employing school board on behalf of a candidate who is currently enrolled in a state-approved program leading to administrative
licensure (superintendent, principal, school business administrator, director of instruction, director of special education and pupil
services, reading specialist, career & technical education coordinator, library media supervisor or instructional technology
coordinator). To request a 1-year extension of a 5-year administrator license, use the PI-1602-5R form.
Send PI-1612 Institutional Endorsement and PI-1613 Experience Verification forms to institutions and employers if required. All
administrator licenses, except business administrator, require eligibility to hold a Wisconsin teaching or pupil services license. If you
do not hold a Wisconsin teaching or pupil services license, DPI must determine eligibility for that licensure, based on your PI-1612
and PI-1613 forms, before issuing a 1-year administrator license. Out-of-State Applicants: If you also wish to be licensed in
Wisconsin for teaching or pupil services you must submit a separate PI-1602-OS (Out-of-State) license application and additional
$150 fee with this application. Forms are available at: http://dpi.wi.gov/tepdl/applications.html.
Type or print legibly in black or blue ink. Do not submit “back-to-back” photocopies since pages of the application are separated for
processing. Keep a copy of the entire application including all documen