1 BEFORE THE TEACHER STANDARDS AND PRACTICES COMMISSION
Q OF THE STATE OF OREGON
3 In the Matter of the ) STIPULATION OF FACTS
4 Licensure of ) AND ORDER OF REVOCATION
5 MlTZl DIANE STACY ) OF RIGHT TO APPLY
6 On August 29, 2005, the Teacher Standards and Practices Commission (Commission)
7 received information that Mitzi Diane Stacy (Stacy), was convicted for Aggravated Theft and
8 Forgery on April 18, 2005, in the State of Oregon for Multnomah County Circuit Court.
9 After review of the matters alleged, Ms. Stacy and the Commission agree that their
1O respective interests, together with the public interest, are best served by a stipulation to certain
11 facts and revocation of her right to apply for Iicensure.
12 This Order sets forth the facts upon which the parties have agreed and the sanction to
13 be imposed. Ms. Stacy stipulates that there are sufficient facts contained in the Commission’s
4 files and records to support the findings of fact and conclusions of law set forth below. In
Q entering into this stipulation, Ms. Stacy waives the right to a hearing to contest the finding of
16 fact, conclusion of law and order set forth below. Ms. Stacy understands that the Commission
17 will revoke her right to apply for Iicensure.
18 This stipulation is contingent upon approval and adoption of the Order by the
19 Commission. lf the Commission does not adopt this Order, neither Ms. Stacy nor the
20 Commission are bound by these Stipulations and Ms. Stacy retains all rights to a hearing on the
21 allegations.
22 STIPULATION OF FACTS
23 1. Ms. Stacy has been licensed by the Commission since October 3, 1997.
24 The Commission issued a Professional School Nurse License to Ms. Stacy on March 18, 1999.
25 Said license expired December 15, 2004.
26 2. There are no prior compiaints or discipline issues in the Commission’s files for
.7 Ms. Stacy.
Page 1 STIPULATION OF FACTS AND ORDER OF REVOCATION OF RIGHT TO APPLY — STACY

1 3. On April 18, 2005, Ms. Stacy was convicted of Aggravated Theft 1 (five counts),
Q ORS 164.057 and Forgery 1 (two counts), ORS 165.013, in Multnomah County Circuit Court.
3 4. The criminal convictions are related to Ms. Stacy‘s submission of unlawful insurance
4 claims for payment for services provided to Ms. Stacy’s severely disabled daughter.
5 IT IS SO STIPULATED:
6 "M \ ‘In! V,l£ ' __\3_:l:_Clc§_—.
7 Mitz' a: e S . , Date
.w _ we?
9 Victori .lain, Executive Director Date
1O Teacher Standards and Practices Commission
1 1 CONCLUSIONS 0F LAW
12 Mitzi Diane Stacy’s criminal convictions for Aggravated Theft 1 (five counts), ORS
13 164.057 and Forgery 1 (two counts), ORS 165.013, constitute Gross Unfitness under OAR 584-
14 020-0040(5)(c). Ms. Stacy failed to maintain the dignity of the profession by respecting and
' obeying the law, exemplifying personal integrity and honesty in violation of OAR 584-020-
16 0035(3)(a). This misconduct constitutes Gross Neglect of Duty. The Commission’s authority to
17 impose discipline in this matter is based upon ORS 342.175.
18 ORDER
19 The Commission adopts the above stipulation of facts and hereby revokes Mitzi Diane
20 Stacy’s right to apply for Iicensure.
21 IT IS SO ORDERED this-9; day of January, 2006.
22 TEACHER STANDARDS AND PRACTICES COMMISSION
23 I flMQ;%/M7 '
24 By / " . I Mb
25 Victoria Chamber aln, Executive Director [1129051
O
Page 2 STIPULATION OF FACTS AND ORDER OF REVOCATION OF RIGHT TO APPLY — STACY