APPLICATION FOR RECOMMENDATION MICHIGAN INITIAL …

APPLICATION FOR RECOMMENDATION MICHIGAN INITIAL STANDARD TEACHING CERTIFICATE

Please note: You must complete all sections of the form. Paper applications will be submitted at the Culminating Seminar.

Last 4 digits of SSN: ________________ G#: ______________________________

Please Print Name (Last, First, Middle):

Phone #:

Birth Date:

Personal E-Mail:

Maiden Name:

Standard Certificate Requested:

Elementary

Secondary

K-12

Semester of Completion:

Race: (Optional) Voluntary cooperation is appreciated as this information is used to compile a study of teacher supply and demand.

Hispanic

Black Non-Hispanic

White Non-Hispanic

Asian or Pacific Islander

Native American

Have you been convicted of any misdemeanors or felonies? YES NO (Selection is REQUIRED or application will not be processed)

If you have ever accepted responsibility in a civil infraction (excluding speeding tickets) or been convicted of or pled no contest to a misdemeanor or felony, you must provide a signed statement of explanation detailing the charge, year of conviction, name and location of court and all circumstances surrounding conviction. In addition, you are required to provide one of the following court documents: Statement of Judgment or Register of Action. This information will be sent to Michigan Department of Education at the time of recommendation.

On the line provided, please write name of the subject area (i.e. Language Arts) and the date (mo/yr) of the test that you have completed and circle "P" if you have passed the test. Do not include subject areas that you have not completed (i.e. have not satisfied all required courses).

Elementary Education

Secondary Education / K-12

Elem Ed Test (date) _______________________________________ P

Major Test 1 (name/date) ___________________________________ P

Major Test 1 (name/date) ___________________________________ P

Major Test 2 (name/date) __________________________________ P

Minor Test 1 (name/date) ___________________________________ P

Minor Test 1 (name/date) ___________________________________P

Major/Minor Test 2 (name/date) ______________________________P

Minor Test 2 (name/date) ___________________________________P

You must apply for certification on the Michigan Department of Education MOECS site. Once Oakland recommends you for the initial Standard Teaching Certificate, you will receive an email from the MOECS system prompting you to pay the application fee. After payment has been processed, MOECS will allow you to print your new teaching certificate from within the system. You will want to have the certificate notarized before you begin your job search.

By signing this application, I am confirming that all information provided is accurate.

Signature:

Date:

FOR INTERNAL USE ONLY GID/NAME SSN/DOB PROGRAM TYPE ENDORSEMENT Major/Minor DEGREE POSTED COURSEWORK NO HOLD ON ACCOUNT FINAL GPA/GPA PRIOR TO ED PROG NOTES:

MTTC BASIC SKILLS TEST 96 MTTC ELEM ED TEST 103 MTTC SUBJECT AREA TESTS OPI ? World Languages Only CURRENT CPR & FIRST AID/PROVIDER CURRENT FELONY/MISDEMEANOR RECOMMENDED LOGGED/SCANNED

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