application for a teacher's license · application for a teacher's license application package ......
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APPLICATION FOR A TEACHER'S LICENSE
Application Package intended for Applicants who
completed their teacher education program outside of Canada
Send all documentation to:
Office of the RegistrarCertification and Standards Section
Department of Education, Early Learning and CultureSuite 101, Holman Centre
250 Water StreetSummerside, Prince Edward Island C1N 1B6
Tel:(902) 438-4130Fax:(902) 438-4062
Effective from August 20, 2016 TL-INT -Eng
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GUIDELINES FOR APPLYING FOR A PEI ACADEMIC TEACHER’S CERTIFICATE FOR APPLICANTS WHO COMPLETED THEIR PROFESSIONAL TEACHER EDUCATION PROGRAM
OUTSIDE OF CANADA Please read the instructions carefully before completing this application for an Academic Teacher’s Certificate
Under Section 67. (1) of the Education Act, an education authority shall not employ a person as a teacher unless the person holds a teacher’s license. A person who applies for a teacher’s license must apply in accordance with section 98 of the Education Act and provide the supporting documents, as outlined below with the application.
ATTENTION APPLICANTS EDUCATED OUTSIDE OF CANDA! As you completed your initial pre-service professionalteacher education program in a jurisdiction outside of Canada, you must provide proof that you were certified first to teach in the jurisdiction where you completed your teacher education program, even if you never taught there.
APPLICATION REQUIREMENTSYou must provide the following documents for the purpose of
an evaluation to obtain a PEI Teacher’s License. [Please note: Some documents should be enclosed with
your completed application form, while others must be sent directly from the issuing institution. A. Enclose with your completed application form:T proof of identity such as a copy of your Birth Certificate
T proof of eligibility to work in Canada such as a copy Social Insurance Number card, work permit etc.
T $175.00 evaluation fee in the form of a cheque or money
order made out to the Minister of Finance. Payment in cash will be accepted in personal at the Office of the Registrar. Credit Card payments may be made of the phone.
T a copy of a Criminal Background Check current to within three
(3) months of the submission of your application
T a copy of a Vulnerable Sector Screen current to within three
(3) months of the submission of your application
T proof that you were certified to teach in the jurisdiction in
which you completed your pre-service teacher education
program (even if you never taught there) such as a copy of
your teacher’s certificate
T a copy of your teacher’s certificate from every additional jurisdiction where you have been certified to teach
T a copy of your degree from each university attended
B. Request the following documents be sent to the Office ofthe Registrar to support your application:
T proof of completion of all post- secondary education such as
an original official transcript(s) sent directly from all post-
secondary institutions where you have attended to the Office
of the Registrar
T proof of completion of a recognized pre-service teacher
education program such as an original official transcript of
marks sent directly to the PEI Office of the Registrar from the
university where you completed your initial pre-service
profession teacher education program.
T proof that your teacher’s license from the jurisdiction where
you completed your initial pre-service professional teacher
education program is valid and in good standing such as a
Statement of Professional Standing. The Statement of
Professional Standing must confirm that your teacher’s
certificate has never been suspended or revoked and that your
teaching license is in good standing in that jurisdiction. This
must be mailed directly from the regulator in the jurisdiction
where you completed your initial pre-service professional
teacher education program. This applies even if you never
taught there.
T proof of professional status from ALL of the jurisdictions
where you have been certified to teach such as a Statement of
Professional Standing. The Statement of Professional
Standing from other jurisdictions where you have taught must
confirm that your teacher’s certificate has never been
suspended or revoked and that your teaching license is in good
standing in that jurisdiction. This applies even if you never
taught there.
PERSONAL BACKGROUND INFORMATION: Proof of Identity:Alternatives to a copy of a Birth Certificate include, a Canadian or Foreign Passport (must include middle names), a Permanent Resident Card (front and back required), a Canadian Immigration Record and Visa Record of Landing (front and back required).
[Please note: Driver’s Licenses, Provincial Health Cards and Canadian Citizenship Cards are not acceptable as proof of identity.]
Proof of Change of Name (if applicable): If your name was changed throughout your educational or work experience, please provide a copy of a legal document which supports this change of name such as a copy of a Marriage Certificate, a Divorce Certificate, a Change of Name Certificate, a Court Order that changed a name.
http://../../../teaching_certificates.aspx?lang=en-CAhttps://www.princeedwardisland.ca/sites/default/files/forms/payment_form.pdf
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Proof of Eligibility to Work In Canada:A Teaching Certificate will not be issued until proof of eligibility
to work in Canada has been provided to the Registrar. For out-of-
country applicants, a valid work permit issued by the federal
government indicating that the applicant is not restricted from
working in a school environment is required on the front and
back of your Permanent Resident Card or Record of Landing
Form.
Conditional Letter of Eligibility In instances where an applicant has met all of the requirements
of teacher certification with the exception that they do not hold
a work permit or proof that they are eligible to work in Canada,
a Conditional Letter of Eligibility will be issued. This will indicate
that your credentials have been evaluated and that you will be
eligible to teach in the public schools of PEI upon providing proof
of permission to work in Canada.
Criminal Background Check & Vulnerable SectorScreen:All applicants must submit an original, or a copy of an original,
of a signed, Canadian criminal record check report including a
Vulnerable Sector Screen. The report must be current to within
three (3) months of the date of submission of your application.
The report must include your current and past full names. These
will have to match your proof-of-identity documents. You can
obtain a criminal record check from a local, regional or national
police service.
ACADEMIC CREDENTIALSOfficial Post-Secondary Transcripts: Official transcripts, bearing the institution’s name and the educational institution’s Registrar’s signature, must be mailed directly from the post-secondary institution to the Office of the Registrar in a sealed envelope. The official transcript must contain the title of the degree that you were awarded and the date when you successfully completed your degree. It must outline the courses and credit hours completed, the completion date as well as the length of the program. You should include a transcript for each university you attended. Only course work completed at an accredited recognized post-secondary institutions will be recognized.
Official Teacher Education Program Transcripts: You must provide proof that you have completed an approved and recognized pre-service teacher education program. The official transcript must contain the name of the degree that you were awarded and the date when you successfully completed your degree.
[Please note: Only initial pre-service professional teacher education programs that are recognized for licensure in the jurisdiction in which they are offered will be considered for certification purposes.]
Your transcript must outline the courses and credit hours completed as well as the length of the supervised practicum. An acceptable pre-service teacher education program must include a minimum of thirty (30) credit hours beyond a minimum of 90 credit hours of undergraduate study plus a supervised practicum of a minimum length of twelve (12) weeks or sixty (60) days.
[Please note: Individuals are asked not to apply for a PEI teacher’s
certificate until such time as they have successfully completed their
teacher training program. Only pre-service teacher education
programs that are completed at an approved accredited post-
secondary institution will be recognized.]
Faxed, e-mailed, photocopied, hand-delivered or copies of
transcripts will NOT be accepted in the Office of the Registrar.
All transcripts m ust be originals sent directly by the post-
secondary institution to the Office of the Registrar. In the event
that the university uses only a secure server system to post
transcripts, we will require the login and password access
information.
Countries or Jurisdictions Where Universities do notIssue Official Transcripts to Third PartiesIn some countries, post-secondary institutions only issue official
original transcripts to the student. In these cases, the applicant
must present these original records to the Registrar in person at the
Office of the Registrar. The Registrar will make a copy and initial that
the original has been viewed. The Registrar will then mail the
transcript to the originating university for verification.
PROFESSIONAL CREDENTIALS
Statement of Professional Standing You must request that an official Statement of Professional
Standing be sent on your behalf from the certification authorities in
ALL jurisdictions where you held a teacher’s certificate even if you
never taught there, including the jurisdiction where you completed
your teacher education program. The statement (s) must confirm
that your teacher’s certificate is valid and is in good standing in the
jurisdiction (s) and that it has never been suspended, revoked or
suspended. The Statement of Professional Standing must be issued
by the Ministry, College or the regulatory body that holds the
authority to license teachers in that jurisdiction. It must be mailed
directly to the Office of the Registrar.
[Please note: The Statement of Professional is NOT a copy of your
teacher’s certificate nor is it an evaluation of your teaching.]
Faxed, e-mailed, copied or hand-delivered copies of Statements
of Professional Standing will NOT be accepted. Statements of
Professional Standing must be sent directly by the regulatory
body to the Office of the Registrar.
When the Statement of Professional Standing is Available Online
Exclusively
In the instance where a jurisdiction only provides the Statement of
Professional Standing online, you will be required to provide the
Registrar with your registration number and any login information
so that your Statement of Professional Standing can be accessed
online by the Registrar.
When there is No Central Authority Responsible for Teacher
Certification
In countries where there are no centralized regulators for licensing
teachers, applicants may provide alternate documentation. Instead,
you must arrange for the head of the last school where you taught
to send a letter of reference directly to the Office of the Registrar.
The letter must be current. It must list the dates and length of your
employment and say that you were never suspended for disciplinary
reason and that your conduct was satisfactory.
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Language Proficiency
To teach in PEI Public School system, teachers must be thoroughly proficient in either English or in French. Applicants must demonstrate effective communication skills in either of English or French. Applicants who have completed a portion of their education in a language other than English or French may be asked by the Registrar to provide acceptable results in an approved language proficiency test. The test results must not be older than one full year from the date of submission of the application. For more information on the International Language Tests that are recognized by the Registrar and for the acceptable scores on these tests, please contact the Office of the Registrar.
PEI Academic Teacher’s Certificate Qualification LevelsThe PEI Registrar evaluates the academic credentials
submitted by each applicant and assigns a qualification level according to the criteria outlined in the Teacher Certification and Standards Board regulations under the authority of the Education Act. Academic credit hours may be weighted differently as well. Every effort is made to ensure that academic credentials are treated equitably. The assignment of a level impacts the pay rate of a contract teacher. Therefore, it is important that you provide the Office of the Registrar with transcripts for all post-secondary studies that you wish
to have evaluated for classification and salary placement purposes. Qualification levels assigned in PEI differ from those in other jurisdictions.
Academic Teacher’s Certificate 4
An Academic Teacher’s Certificate Level 4 may be granted to
an applicant who has successfully completed an approved pre-service teacher education program and a minimum of
one-hundred and twenty (120) approved credit hours of
post-secondary study. This could include: an approved
ninety (90) credit hour undergraduate degree along with an approved thirty (30) credit pre-service teacher education program or an approved one hundred and twenty (120) credit hour bachelor of education degree.
Academic Teacher’s Certificate 5
An Academic Teacher’s Certificate Level 5 may be granted to
an applicant who has successfully completed an approved pre-service teacher education program and a minimum of
one hundred and fifty (150) approved credit hours of post-secondary study. This could include an approved one hundred and twenty (120) credit hour undergraduate degree plus an approved teacher education program of a minimum of thirty (30) credit hours or a consecutive bachelor and bachelor of education program of a minimum of one hundred and fifty (150) credit hours.
Academic Teacher’s Certificate 5A
An Academic Teacher’s Certificate Level 5A may be granted to
an applicant who has successfully completed a minimum of an approved one full academic year of study totalling thirty (30) credit hours beyond the Certificate 5 totalling a minimum of one hundred and eighty (180) credit hours where the additional course work did not result in the granting of a masters degree.
Academic Teacher’s Certificate 6
An Academic Teacher’s Certificate Level 6 may be granted to an
applicant who has successfully completed an approved one full year
of academic year of study totalling thirty (30) credit hours beyond
the Academic Teacher’s Certificate Level 5 totalling a minimum of
one hundred and eighty (180) credit hours and an approved
academic master's degree. The Masters degree must be in an area
related to the authorized PEI Public School system curriculum.
Academic Teacher’s Certificate 7
Beginning in October 2013 the achievement of an approved doctoral
degree or an approved additional masters degree resulting in a
minimum of two hundred and ten (210) credit hours beyond the
Academic Certificate 6 may be recognized for a Academic Teacher’s
Certificate 7. The additional degree must be in an area related to the
authorized PEI Public School system curriculum. There are currently
no salary implications associated with this level.
Appeal Policy
An applicant may appeal the decision of the Registrar to 1) either refuse a license or 2) to assign a certain level to an applicant’s certificate to the Teacher Certification and Standards Board.
An appeal must be requested no later than 15 days from the date when the decision was provided to the applicant. For more information on the appeal process, contact the Registrar.
Document Policy:
All documents received by the Registrar become the property of the Department of Education, Early Learning and Culture. Applicants are advised to make copies of each document before submitting them to the Registrar. The Office of the Registrar will not provide third parties with copies of your documents. An application file that is inactive for one full year will be destroyed.
Translation Policy:
All documents must be received in the official language of the granting institution. When the Registrar receives official documents from the granting institution that are in a language other than English or French, you will be required to provide official translations. We will provide you with a copy of each document. You must use these copies to arrange for official translation. Translations will only be accepted from a document translation service that has been approved by the Registrar. This could include the consulate or high commission or embassy in Canada of the country that issued the documents or a translator that has been accredited by the federal or provincial government.
Effective Date:
An Academic Teacher’s Certificate becomes effective from the date when the Office of the Registrar has received all of the required documentation and in the event that all documentation has been approved by the Registrar and meets the requirements outlined in Teacher Certification and Standards Boards policies. An Academic Teacher’s Certificate remains valid from the date of issue unless suspended, revoked or cancelled.
It is your duty to report within 48 hours to the Registrar any charges or convictions under the Criminal Code of Canada or the Controlled Drugs and Substances Act of Canada.
http://www.gov.pe.ca/go/reg
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EMPLOYMENT ISSUES
Island Employers
Teachers seeking employment in Prince Edward Island must apply to the employers directly. There are two public school K to 12 systems in PEI; the English system and the French system. You may request in Section 6 of this application form to have your certification information forwarded to one or both school systems, the English and/ or the French. You may also indicate in Section 5 if you wish to receive a Verification of your Eligibility to Substitute Teach.
Seeking Employment Outside of PEI
Should you wish to apply outside of PEI, you may require that the PEI Registrar issue a Statement of Professional Standing on your behalf. You may request this using the application form found on our web site.
Recognition of Teaching Experience
If you have accumulated experience teaching outside of Prince Edward Island, or in other venues, you may qualify to receive recognition for this experience under the Registrar's Work Experience policy. You must apply for service recognition to the Registrar. Once an evaluation of your teaching experience has been completed, the Office of the Registrar will inform
the education authoriaties (school board (s)) as requested by yourself.
To Apply for Recognition for Teaching Experience within a Public School System Outside of PEI
You may have teaching experience in a public school system outside of Prince Edward Island that qualifies for service recognition in this province. Recognition for teaching experience includes contractual, short-term contractual and substitute outside of Prince Edward Island not exceeding one hundred and eighty-five (185) days in each school. This may be granted
by the Registrar upon application.
You may complete the application form for work experience recognition and submit it with your application for a P.E.I. Academic Teacher’s Certificate. Support letters from former employers will be required.
[Please note: Teaching experience that was a result of a Teacher Practicum is not eligible for work experience recognition.]
To Apply for Recognition for Allied Work Experience
The Allied Work Experience program provides an opportunity
for certified PEI teachers to apply for and receive recognition for past work experience that involves teaching in settings outside of the regular K to 12 public school system or that is similar to or related to teaching.
You may attach the Work Experience Application form with this application. Please note letters from employers will be required to support all applications for Work Experience Recognition.
{Please note: Teaching experience that was a result of a Teacher Practicum is not eligible for work experience recognition.]
FEE POLICY The required fee of $175.00 (Canadian funds) as well as the completed application form and required documentation must be received by the Office of the Registrar before an application for a teacher ’s certificate will be evaluated or issued. The fee is non-refundable unless
the application is withdrawn and in the event that no staff time has been invested in processing the application. The application fee must be paid by cheque or by money order made out to: The Minister of Finance. Or, it can be paid in cash in person at the Office of the Registrar. Forward the application and all supporting documents to:
The Office of the Registrar
Certification and Standards Section
Department of Education, Early Learning and Culture
Suite 101, Holman Centre
250 Water Street, Summerside, PEI C1N 1B6
PAYING BY CREDIT CARD:To pay the $175.00 evaluation fee by credit card, you must complete the Province of Prince Edward Island Request to Pay by Credit Card Over the Phone Form.
PROCESSING TIME:Applications are processed on a first in, first out basis. Please
allow three (3) weeks from the date when all required documentation has been received by the Office of the Registrar.
INQUIRING ABOUT THE STATUS OF YOURAPPLICATION:If you having questions concerning the receipt by the Office of
the Registrar of transcripts and/ or other documents or to inquire about the status of your application, you are kindly asked to contact the Office of the Registrar via e-mail at: [email protected] In the subject line of your email please write “Status Update Requested”. In the body of your e-mail clearly identify yourself, the nature of your application and your inquiry.
OBTAINING ASSISTANCE:Other inquiries may be directed to the Registrar’s Administrative Assistant by calling (902) 438-4130.
FOR FURTHER INFORMATIONWhen seeking information on teacher certification in general,
on applying for substitute teacher authorizations and on obtaining recognition for teaching experience outside of Prince Edward Island please visit the Certification and Standards web site found at:
http://www.gov.pe.ca/go/reghttps://www.princeedwardisland.ca/sites/default/files/forms/statement_of_professional_standing_0.pdfhttps://www.princeedwardisland.ca/sites/default/files/forms/payment_form.pdfhttps://www.princeedwardisland.ca/sites/default/files/forms/eelc_evaluation_of_teaching_exp_2016.pdfhttps://www.princeedwardisland.ca/sites/default/files/forms/eelc_alliedworkexp_eval_2015.pdfhttps://www.princeedwardisland.ca/en/information/education-early-learning-and-culture/teacher-certification
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Application Form for an Academic Teacher's Certificatefor applicants who completed their Teacher Education Program Outside of Canada
1. REQUIRED DOCUMENTATION Please indicate the documents you are enclosing (Enclosed) with this application form, thedocuments which you have requested (Requested) to be sent on your behalf and any documentation which is not applicable to your application (N/A).
Enclosed Requested N/A
1. Proof of Identity such as a copy of your birth certificate
2. Proof of eligibility to accept employment in Canada such as a copy ofyour social insurance card
3. Copy of a Criminal Background Check current to within three (3) monthsof the date of submission of the application.
4. Copy of a Vulnerable Sector Screen current to within three (3) monthsof the date of submission of the application.
5. Proof of completion of all post-Secondary studies in the form of officialtranscripts sent directly from the relevant post-secondary institution(s)
6.Proof of completion of a recognized pre-service teacher educationprogram in the form an official transcript of marks from the universitywhere you completed this program
7. Proof of your authorization to teach in the jurisdiction in which youcompleted your teacher education program in the form of a copy of yourteaching certificate even if you never taught there
8. Proof of professional teaching status from the jurisdiction where youcompleted your teacher education program in the form of an officialStatement of Professional Standing sent directly to the Office of theRegistrar from the regulatory body even if you never taught there
9. Proof of certification form all jurisdictions where you taught and/ orwere certified to teach outside of the jurisdiction where you completedyour teacher education program in the form of a copy of the relevantteacher’s certificate even if you never taught there
10. Proof of Professional Status such as a Statement of ProfessionalStanding from ALL other jurisdictions where you have taught and /or havebeen certified to teach even if you never taught there
11. $175.00 evaluation fee in the form of a cheque or money order madeout to the Minister of Finance, by credit card or in cash in person.
2. IDENTIFICATION
First Name Middle Name Surname*
Date of Birth Place of Birth
Social Insurance Number:
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*If you were educated or previously certified in a name other than that used above please indicate your former name below. Also, please provide copies ofdocumentation to support this legal name change such as a copy of your Marriage Certificate, Divorce Certificate, Certification of Name Change, Court Order
Other Name:
Describe the document you are providing to support the name change:
3. CONTACT INFORMATION
MAILING ADDRESS:
Street, P.O. Box:
Community, Town, City: Province, State:
Country: Postal Code:
Telephone Number: E-mail Address:
4. EDUCATION
HIGH SCHOOL EDUCATION
Name and Address of High School:
Grade Completed Year Completed
POST SECONDARY EDUCATION Official transcripts are required for ALL post secondary study that youcompleted. Official Transcripts must be sent directly to the Office of the Registrar at the aboveaddress from the Post-Secondary Institution.
TEACHER EDUCATION PROGRAM Indicate here the program that you completed that is recognized forTeacher Certification in the jurisdiction where it is offered.
Name and Address of Post Secondary Institution Where You Completed YourPre-Service Teacher Education Program:
Name of Credential Achieved:
Dates Attended: From: To:
OTHER Indicate here degrees, diplomas, certificates, course work completed etc.
Name and Address of Post Secondary Institution Name of Credential Achieved:
Dates Attended: From: To:
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Name and Address of Post Secondary Institution: Name of Credential Achieved:
Dates Attended: From: To:
Name and Address of Post Secondary Institution: Name of Credential Achieved:
Dates Attended: From: To:
Include additional studies on separate sheet.
LANGUAGE OF
INSTRUCTION
Primary Secondary Post-Secondary Post Secondary Post
English English English English
French French French French
Other Other Other Other
5. PREVIOUS TEACHING EXPERIENCE Please include name of school(s) and school board(s)/ district (s) whereyou taught, number of years. To receive credit for out-of-province experience see below.*
Name and Address of School: Name and Address of School
District
From: To:
Name and Address of School: Name and Address of School
District:
From: To:
Name and Address of School: Name and Address of School
District:
From: To:
*To obtain service recognition for your previous teaching experience outside of Prince Edward Island, you must applyusing the application form found on the web site at: http://www.gov.pe.ca/forms/pdf/1916.pdf
6. EMPLOYMENT IN PRINCE EDWARD ISLAND
APPLYING TO PEI SCHOOL BOARDS Indicate to which employer you wish to have your certification information sent.
Public Schools Branch Commission scolaire de langue française
Department of Education Other
APPLYING TO SUBSTITUTE TEACH Holders of a valid PEI Teacher’s Certificate are eligible to
substitute teach in PEI public schools. Please indicate if you wish to receive a Verification of Eligibility as a Substitute Teacher.
Yes, please issue a Verification of Eligibility as a Substitute Teacher No, I do not wish to be issued a Verification of Eligibility as a Substitute Teacher
If yes, please indicate the school board (s) where you would like your Authorization to Substitute for aTeacher to be sent.
Public Schools Branch Commission scolaire de langue française
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7. PERSONAL BACKGROUND DISCLOSURE QUESTIONS All questions in this section must be answeredunless otherwise indicated. For every affirmative answer (yes), please attach a written explanation on aseparate piece of paper referencing the question number
1. Have you ever been convicted, given an absolute or conditional discharge, or received a pardon for acriminal offence or are there any outstanding charges against you?
9Yes 9 No
2. Have you ever had an application for a teacher’s certificate in any other jurisdiction rejected?
9Yes 9 No
3. Have you ever been found guilty of misconduct by a teaching authority or other educationalorganization?
9Yes 9 No
4. Have you ever, for any reason other than non-payment of fees had a teacher’s certificate suspendedor revoked in another jurisdiction?
9Yes 9 No
5. Have you ever had an application for an Authorization to Substitute for a Teacher suspended orrevoked?
9Yes 9 No
Submission of an application that is misleading or false, in whole or in part, may lead to the denial ofcertification.
DECLARATION
Under Section 98 of the Education Act, the Registrar may refuse or suspend a teacher's license to a person who misrepresents his or her qualifications in an application for a teacher’s license or who fails to possess the qualifications required under the Act at the time the teacher’s license was issued.I declare that all information given on this application is true, correct and complete to the best of my knowledge and I hereby authorize the Department of Education, Early Learning and Culture to verify the above information. I accept responsibility for advising the Department of Education, Early Learning and Culture for advising, in writing, of any change to the information contained in the Personal Background Information section.
Signature Date
Personal information on this form is col lected under sect ions 98 and 100 of the Education Act R.S.P.E. I . 1988, Cap. E-02 and wi l l be used for the purpose of ver i fy ing identity and educat ional credentia ls . I f you have any quest ions about this col lect ion of personal information, you may contact the Off ice of the Registrar , Cert i f icat ion and Standards Sect ion, Department of Educat ion, Ear ly Learning and Culture, Holman Centre Suite 101, 250 Water Street , Summerside, PEI C1N 1B6 Telephone 902-438-4130
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Date of Birth: Place of Birth: Social Insurance Number: Other Name: Describe the document you are providing to support the name change: 3 CONTACT INFORMATION MAILING ADDRESS Street PO Box: Community Town City: Province State: Country: Postal Code: Telephone NumberRow1: Email AddressRow1: Name and Address of Post Secondary Institution Where You Completed Your PreService Teacher Education Program: Name of Credential Achieved: Dates Attended From To: Name and Address of Post Secondary Institution: Name of Credential Achieved_2: Dates Attended From To_2: Name and Address of Post Secondary Institution_2: Name of Credential Achieved_3: Dates Attended From To_3: Name and Address of Post Secondary Institution_3: Name of Credential Achieved_4: Dates Attended From To_4: Other_2: Name and Address of School: From: To: Name and Address of School_2: Name and Address of School District_2: From_2: To_2: Name and Address of School_3: Name and Address of School District_3: From_3: To_3: Signature: Date: Check Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: OffCheck Box9: OffCheck Box10: OffCheck Box11: OffCheck Box12: OffCheck Box13: OffCheck Box14: OffCheck Box15: OffCheck Box16: OffCheck Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20: OffCheck Box21: OffCheck Box22: OffText23: Text24: Text25: Text26: Text27: Text28: Check Box29: OffCheck Box30: OffCheck Box31: OffCheck Box32: OffCheck Box33: OffCheck Box34: OffCheck Box35: OffCheck Box36: OffCheck Box37: OffCheck Box38: OffCheck Box39: OffCheck Box40: OffText41: Text42: Text43: Text44: Check Box45: OffCheck Box48: OffCheck Box49: OffText50: Check Box51: OffCheck Box52: OffCheck Box53: OffCheck Box54: OffCheck Box55: OffCheck Box56: OffText57: Check Box58: OffCheck Box59: OffCheck Box60: OffText61: Name and Address of School District: Other_5: Check Box62: OffCheck Box63: OffCheck Box64: OffCheck Box65: OffCheck Box66: OffCheck Box67: OffCheck Box68: OffCheck Box69: OffCheck Box70: OffCheck Box71: OffCheck Box72: OffCheck Box73: OffCheck Box74: OffCheck Box75: OffCheck Box76: OffCheck Box77: OffCheck Box78: OffCheck Box79: OffText80: Text4: REQUEST TO PAY BY CREDIT CARD OVER THE PHONE Text6: APPLICATION FOR A STATEMENT OF PROFESSIONAL STANDING Text8: APPLICATION FOR SERVICE RECOGNITIONText10: APPLICATION FOR ALLIED WORK EXPERIENCE RECOGNITIONText12: REQUEST TO PAY BY CREDIT CARD OVER THE PHONE FORMText14: TEACHER CERTIFICATION AND STANDARDS WEB SITE