Materials Enclosed- Please Submit as a Complete Packet
NON-PUBLIC SCHOOLS APPROVED UNDER COMAR 13A.09.10 REQUEST FOR CERTIFICATIONTo be completed by Education Director/Certification ContactApplicant: FORMTEXT ?????Certification Contact: FORMTEXT ?????Contact Phone: FORMTEXT ?????SSN (Last 4 Digits): FORMTEXT ????? School Name: FORMTEXT ????? Contact Email: FORMTEXT ?????Date Hired as Educator of Record: FORMTEXT ?????Date Submitted to MSDE: FORMTEXT ?????Assignment: FORMCHECKBOX Type I/II SPED: Grades: FORMTEXT ????? FORMCHECKBOX Type I/II GEN ED: Subject/s: FORMTEXT ????? Grades: FORMTEXT ????? FORMCHECKBOX Music/Art/Health/P.E.Certificate: FORMCHECKBOX Initial: Certification Area/Grade Band: FORMTEXT ????? FORMCHECKBOX Renew/Reinstate: FORMDROPDOWN FORMCHECKBOX Endorsement: Certification Area: FORMTEXT ????? FORMCHECKBOX Evaluation: Certification Area: FORMTEXT ????? FORMCHECKBOX Test Scores FORMCHECKBOX Credit CountMaterials Enclosed- Please Submit as a Complete Packet FORMCHECKBOX Verification of Criminal History Record Check must be submitted for each new hire; copy attached. FORMCHECKBOX An Educator Application must be submitted for each new hire; copy attached.ConditionalConditional RenewalSPC I FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts FORMCHECKBOX Test scores(if applicable) FORMCHECKBOX Verification of experience (if applicable) FORMCHECKBOX Out of state certificate (if applicable) FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts FORMCHECKBOX Test scores(if applicable) FORMCHECKBOX Verification of experience (if applicable) FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts FORMCHECKBOX Test scores(if applicable) FORMCHECKBOX Verification of experience FORMCHECKBOX Out of state certificate (if applicable) FORMCHECKBOX Copy of license (specialist) APC FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts/CPD form FORMCHECKBOX Conferred Master’s Degree OR FORMCHECKBOX 36 post back credits (min 21 grad, max 15 under-grad or CPD credits OR FORMCHECKBOX National Board Certification AND 12 graduate credits FORMCHECKBOX CEUs (specialist) FORMCHECKBOX Copy of license/s (specialist) FORMCHECKBOX 3 yrs verification of exp. FORMCHECKBOX Out of state certificate (if applicable) FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts/CPD form FORMCHECKBOX Test scores(if applicable) FORMCHECKBOX Verification of experience FORMCHECKBOX Out of state certificate (if applicable) FORMCHECKBOX Senior teacher waiver (with letter from Ed Director) FORMCHECKBOX 6 equivalent MANSEF credits FORMCHECKBOX Copy of license/s (specialist) FORMCHECKBOX CEUs (specialist) FORMCHECKBOX Pay online FORMCHECKBOX $10 MO/Certified/Cashier FORMCHECKBOX Official transcripts FORMCHECKBOX 3 yrs verification of experienceSPC II APC Renewal ................
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