REQUEST FOR ISSUANCE OF AN INITIAL - Florida Department …
Florida Department of Education Bureau of Educator Certification Room 201, Turlington Building
325 West Gaines Street Communication Number Tallahassee, FL 32399-0400
Applicant’s Personal Information
Social Security Number First Name
WAIVER2017
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DOE Number Last Name
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Date of Birth (MM/DD/YYYY)
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Initial Certificate Fee Waiver Request Form
Extraordinary, Extenuating Circumstances
Relating to Hurricane Maria 2017
The educator identified above is an employee or prospective employee in the Florida public school district or Florida nonpublic school with a state-approved program for demonstration of professional education competence (PEC). This educator experienced extreme loss of property or personal hardship from the natural disaster of Hurricane Maria resulting in displacement from a U.S. territory.
Due to these extraordinary, extenuating circumstances, our school district/nonpublic organization is requesting that the educator certification requirements indicated below be waived for an initial Florida educator certificate pursuant to the Commissioner of Education’s authority in Section 1012.56(16), Florida Statutes.
Please check the applicable box(es) below to indicate the requirements to be waived for this educator:
□ Waiver of the application fee(s) requirement for an initial educator certificate, pursuant to Rule 6A-4.0012(1)(a), Florida Administrative Code (F.A.C.), with requests not to exceed three (3) subject area coverages or endorsements.
□ Waiver of the requirement to provide official transcript(s) documenting receipt of a bachelor’s or higher degree from an accredited or approved institution, pursuant to Rule 6A-4.0012(3), F.A.C. In lieu of official transcript(s), the educator has provided unofficial transcript(s) and, if applicable, copies of valid teaching certificate(s) issued by another state or U.S. territory.*
|Name of School District or Nonpublic Organization |
| | | |
|Signature of Superintendent or Authorized Designee | |Date |
* If submitting unofficial transcripts, the school district/nonpublic organization employer must submit an issue request for a Temporary Certificate. Official transcripts shall be required prior to issuance of a Professional Certificate.
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