EXPEDITED SERVICE REQUEST FORM - Office of Higher ...
EXPEDITED SERVICE REQUEST FORM
| |(Last) |(First) |
|Applicant’s | | |
|Name | | |
| |Is the Online Application Ready for |Has your BOCES submitted documentation to the Office of Teaching? |
|SSN: |Review? |Yes, date: |
|(last four digits) |Yes No |Blue/Green/Pink Sheet (Underline One) |
| | |No |
| |Has Applicant Applied to Your BOCES? | |
| |Yes No | |
|Has your BOCES completed the |If yes, verify the following: |If no, verify the following: |
|evaluation? | | |
|Yes, date |Passed all required exams |Passed all required exams |
|No |Required workshops completed |Required workshops credited |
| |All academic requirements met | |
|Certificate Title Requested: | |
| | |
|Title of Position Offered | |
|Employing School District | |
| | |
|Name of School District | |
|Superintendent | |
| | |
|School District Address | |
|Superintendent’s | |Sup’ts | |
|E-Mail Address | |Telephone | |
| | |Number | |
|Name of Regional Certification|Print/Type Name: | |RCO’s Email Address: |
|Officer (RCO) | | | |
|Submitting Request | | | |
| |RCO’s address: | |Date: |
| | | | |
|Office of Teaching Initiatives Use Only: |
| |If no, check reason for not issuing: |
|Date Received: |Exams |
| |Workshops |
|Date Completed: |Coursework |
| |Fingerprints |
|Was Certificate Issued: Yes No |Notes: |
| | |
|Last Name of Evaluator: | |
Complete and email this form to tcregcert@mail.. If you are forwarding documentation received by your BOCES, attach a copy of this form to your submission and mail to the NYS Education Department, Office of Teaching Initiatives, Room 5N, 89 Washington Avenue, Albany, NY 12234 – Attention: Box ES.
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