APPLICATION FOR OKLAHOMA SCHOOL CERTIFICATE

[Pages:4]APPLICATION FOR OKLAHOMA SCHOOL CERTIFICATE

GENERAL CERTIFICATION INFORMATION

This application is used for applicants qualifying for a teaching certificate.

CERTIFICATES are issued to educators who have completed an approved teacher education program or hold a teaching credential from another state.

CERTIFICATION FEES:

?? The application fee for an Oklahoma certificate is $50.

?? All other transactions (adding new areas, duplicates, degree changes) are $25 per application.

?? Payment may be made by check, cashier's check,or money order payable to the Oklahoma State Department of Education (OSDE). The fee for requesting certification is nonrefundable.

The state agency with authority and responsibility for teacher testing is the Office of Educational Quality and Accountability (OEQA). For information regarding testing registration, contact the OEQA at (405) 522-5399, 840 Research Parkway, Suite 455, Oklahoma City, Oklahoma 73104, .

FINGERPRINTING INFORMATION:

Al l first-time credentialed Oklahoma teachers are required to have on file with the Oklahoma State Board of Education (OSBE) a current Oklahoma criminal history record from the Oklahoma State Bureau of Investigation (OSBI) as well as a national fingerprint-based criminal history record provided by the Federal Bureau of Investigation (FBI). (70 O.S. ? 6-190; OAC 210:20-9-91)

This applies only to individuals applying for their first Oklahoma credential. It does not apply to renewals.

If you have questions concerning whether this law pertains to your eligibility for certification, contact the Professional Standards Section at (405) 521-3337 or .

IMPORTANT NOTICE

Title 68 O.S. ? 238.1 (effective May 31, 2001) requires that all certificate holders be in compliance with Oklahoma state income tax laws before a teaching certificate can be renewed.

The Department of Education is mandated to provide to the Oklahoma Tax Commission a list of individuals who are applying for certification renewal.

The Tax Commission will contact any person who appears to be in noncompliance.

Please contact the Oklahoma Tax Commission's Professional Compliance Unit, (405) 522-6800, with any questions.

In the event an educator's certificate cannot be renewed due to failure to comply with Oklahoma's tax laws, the renewed certificate will be dated the date the State Department of Education receives notice from the Tax Commission that the educator has come into compliance.

Additional instructions are continued on the back of this page.

PROCESSING INSTRUCTIONS

(Continued)

OKLAHOMA GRADUATES

??Applicants completing a higher education program must have a higher education institution

recommendation (Part II). Transcripts must show verification of degree. Applications for career and technology education certification should then be forwarded by the higher education representative to the appropriate program administrator at the Oklahoma Department of Career and Technology Education, 1500 West Seventh Avenue, Stillwater, Oklahoma 74074-4364, telephone (405) 377-2000.

PROVISIONAL LEVEL I CAREER AND TECHNOLOGY EDUCATION APPLICANTS

If the Provisional Level I Career and Technology Certificate is requested, the signature of the employing district superintendent is also required. Applications must be filed through the appropriate program administrator at the Oklahoma Department of Career and Technology Education, 1500 West Seventh Avenue, Stillwater, Oklahoma 74074- 4364, telephone (405) 377-2000.

OUT-OF-STATE APPLICANTS

Applications may be approved by the Oklahoma State Department of Education if applicant holds a full out-of-state credential; the higher education institution (Part II) or Oklahoma State Department of Career and Technology Education (Part III) signature is not required. For additional information and eligibility options, refer to "Out-ofState Applicants" brochure or Oklahoma State Department of Education Web site, , Site Index, Professional Standards. If you have a certificate issued by the National Board for Professional Teaching Standards, please enclose a copy.

??Enclose a copy of the front and back of your full out-of-state credential.

??Verification of out-of-state teaching experience is required by having districts complete a proof of teaching

form. You may request a proof of teaching form from this office or access the Oklahoma State Department of Education Web site at , Site Index, Professional Standards.

To receive credit for years of experience, please include a copy of your out-of-state certificate that was valid during the dates of service.

SCHOOL NURSE APPLICANTS

Please enclose a copy of your current Oklahoma registered nurse's license.

PROCESSING INSTRUCTIONS

Mail application packet to:

Oklahoma State Department of Education, Teacher Certification Section - Room 212, 2500 North Lincoln Boulevard, Oklahoma City, Oklahoma 73105-4599.

Telephone: (405) 521-3337. Oklahoma State Department of Education Web site:

Submit all materials including fee in one packet. See next page for more information.

Did you include:

___ Completed Application? ___ $50 Processing Fee?

___ Official Transcripts? ___ Copy of Out-of-State Credential?

___ Proof of Teaching Form? ___ Signature/Date in Part V?

REVISED JANUARY 2018

!01-001CERT! APPLICATION FOR OKLAHOMA SCHOOL CERTIFICATE

Name

Last

Address

First

Middle

Street or Rural Route Number

Maiden

FEE:

City

(

)

Daytime Telephone Number

(

)

Other number where you can be reached

State

Zip Code

(

)

Evening Telephone Number

E-Mail Address

Social Security Number:

If you have an out-of-state certificate, please check. If your name has changed since your last certificate, please check.

Highest Degree Conferred

LEAVE THIS SPACE BLANK

PART I: CERTIFICATE AREA(S) REQUESTED

(Elementary Education, Intermediate Mathematics, Superintendent, Nurse, Library Media Specialist, etc.)

PART II: RECOMMENDATION FROM THE DIRECTOR OF TEACHER EDUCATION

Oklahoma Graduates Only FOR COLLEGE USE ONLY

Certificate Area

- 7 - 7 - 7

Grade Level

Certificate Area

- 7 - 7 - 7

Grade Level

Highest Degree (Code) ........... Degree Date ....................... College Code (Degree) .......... College Code (Recommending)

Signature of Official Higher Education Institution Representative

Date

PART III: TO BE USED FOR CAREER AND TECHNOLOGY EDUCATION CERTIFICATE(S)

Oklahoma Graduates Only

Applications for career and technology education certificate(s) must be made through the appropriate state program administrator at the Oklahoma Department of Career and Technology Education. These occupational divisions are:

Agricultural Education

Career and Technology Business

Career and Technology Home Economics/Family and Consumer Sciences

Marketing Education Trade and Industrial Education

Health Occupations Education

Please check () the occupational division for which you are applying.

For Provisional Level I Career and Technology Certificate in:

Signature

(District Superintendent or Official Representative)

(Certificate Area)

Date

Signature

Date

(Oklahoma Department of Career and Technology Education state program administrator or representative)

IMPORTANT

Complete educational information and criminal history disclosure statement on reverse. REVISED JANUARY 2018

PART IV:

I hold or have held an OKLAHOMA CERTIFICATE(S):

PART IV:

Type of Certificate

Issue Date

I hold or have held an OKLAHOMA CERTIFICATE(S):

Expiration Date

Name When Certificate Was Issued

Type of Certificate

Issue Date

Expiration Date

Name When Certificate Was Issued

Do you have a certificate issued by the National Board of Professional Teaching Standards? Yes ______ No ______ If yes, please enclose verification or a copy.

PDIfAoyReyso,TuphlVeaav:see

a certificate issued by the National enclose verification or a copy.

Board

of

Professional

Teaching

Standards?

Yes ______ No ______

Pursuant to legislation, Title 70 O.S. 1991, ? 3-104 and 3-104.1, every applicant is required to answer each of the following questions:

PART V:

1. During the preceding ten-year period, have you been convicted of a felony?....................................................... Yes ____ No ____

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13.. DHcouanvrtieenngydotehureeepv(nreeorcbceeodeninntegcsotte)n,nvo-iyrcetreaedrcpeinievrOeiodkdla,ahhsuaosvmpeaey,nowduehdbetesheeennrtceuonpncovenifcaotervdaerocdfriicamtfeoerlooprnlayen?a.ao..tf.t.e.g.m.u..ip.l.tt.y.t.o.o..cr..ou..mp..o.m.n..i.ta..a.p..cl.er..ia.m..o.e.f..wn..oh..li.o.c.h.... Yes ____ No ____ 2. Disucroinngsidtheerepdresceexduianlglyterenl-ayteeadripnenriaotdur,eh?a.v..e...y..o.u...b..e..e..n...c..o..n..v..i.c.t.e..d...o..f..a...c..r.i.m...e...i.n..v..o..l.v..i.n..g...m...o..r.a..l..t.u..r..p..i.t.u..d..e..?.............................. YYeess ________ NNoo ________

34.. HHaavvee yyoouu eevveerr bbeeeenn ccoonnvviicctteedd,inreOcekivlaehdoamsau, swphenetdheedr suepnotnenacve,erodricretcoerivpeledaaodfegfueirlrteydojrudupgomnenatpfloeraaocfrnimoleo or caottnetmenpdteedrec(rnimoecownhtiecsht)w, oarsrceocnesivideedreadsusespxeunadlleydresleantteedncine nfoartuarecriinmaenoyroathnearttsetamteptotrojucorimsdmicittioanc?ri.m...e...w...h..i.c.h..... Yes ____ No ____

5. iHsacvoensyioduereevdersehxaudalaldyvreerlsaeteadctiinonnattaukreen? .a..g..a.i.n..s..t..a..n..y...e.d..u..c..a..t.o..r..c..e..r.t.i.f..i.c..a.t.e...i.n...O...k..l.a..h..o..m...a...o..r..a..n..y...o..t.h..e..r.................... Yes ____ No ____ 4. Hstatveeoyrojuureivsdericbtieoenn?c..o..n..v..i.c..t.e.d..,..r..e..c.e..i.v..e..d...a...s.u..s..p..e.n..d..e..d...s..e.n..t.e..n..c..e..,..o..r..r.e..c..e..i.v..e.d...a...d..e..f.e..r.r..e.d...j.u..d..g..m...e..n..t..f.o..r...a..c..r.i..m...e..o..r... Yes ____ No ____ 6. aIsttaenmypatecdtiocnrimnoewwpheicnhdiwngasacgoaninssidt eyroeud fsoerxaulallelgyerdelmatiesdcoinndnuactturine ainnyansychoothoel rdsistatrtiecto,rcjouurrist,doicrtiboenf?or..e..a..n..y........... Yes ____ No ____ 5. HedauvceatyooruliecveenrsihnagdaagdevnecryseinacOtikolnahtaokmean oargainnystoathneyresdtautceaotorrjucerirstdifiicctaitoeni?n..O...k.l..a.h..o..m...a...o..r..a..n..y...o..t.h..e..r..................... Yes ____ No ____ 7. sDtaoteyoour jcuurrirsednictltyiohna?v.e...a..n..y...o..u..t.s.t.a..n..d..i.n..g...c..r.i.m...i..n.a..l..c..h..a..r.g..e..s..o..r...w..a..r..r.a..n..t.s..o..f...a.r..r.e..s.t..p..e..n..d..i.n..g...a..g..a..i.n..s.t..y..o..u...i.n.................. Yes ____ No ____ 6. IOskalnayhoamctaioonrninowanpyeontdhienrgsatagtaeinosrt jyuoruisdfoicrtaiollne?ge..d...m...i.s..c.o..n..d..u..c..t..i.n...a..n..y...s.c..h..o..o..l..d..i.s..t.r.i.c..t.,..c..o..u..r.t.,..o..r...b..e.f..o..r.e...a.n..y............ Yes ____ No ____

educator licensing agency in Oklahoma or any other state or jurisdiction? .......................................................... Yes ____ No ____ 7Ijouf.frftiihscedDOiaiaokclnltcyaisoehowrnouteimyfrciouaetourdorearwcnnoietnyplryeiaoenhfscyahtovhaofeertaghapleelnrdrcey/soccoteuoaudrnttetivsnatiogacnrntdqejd/uduoirn.erisgsptYdiocoiorclniiutcmsioemiinnsra?ea"ycl.Y.oc.b.reh.ed.sa.s,.rr"..ge..qes.t.su.a.iot.re.er..do.w.n.ta.o.ra.r.o.as.nb.e.tt.p.sa.ai.orn..af..taa.en.r.dr.s.eh.s.pe.t.re.op.t.ve.o.ni.fd.d.ep.i.na.t.gop..e.at.rh.g.te.ah.i.nOe..s.kn.t.la.ya.t.ohu..uor.e.m.i.no.a.f..S.t.ht.a.e.t.e.c.h.D.a..er..gpeaYratemnsde_ni_nt_ow_fhNEaotduc_oc_au_tri_toonr, ITfhteheOaknlsawhoemr tao SantayteofDtehpeaprtrmeceendtinogf qEudeusctiaotniosnish"aYs eths,e" astuattheoorintya tsoepraerqautiereshseteateofanpdapnearttihoenanlat(ufirnegoefrpthrientc-hbaarsgeed)anfdeloinnywhbaatcckogurortunodr jcuhreicsdkiscotinonanyyouapwpleirceancth.arIgf eadb/caocnkvgircotuendd. cYheocukmisayrebqeuireqdu, irtewdiltloboebatat itnheanadppplircoavnidt'es teoxptheensOe.klahoma State Department of Education, official certified copies of all court and/or police records. The Oklahoma State Department of Education has the authority to require state and national (fingerprint-based) felony background cAhreeckysouonaaUnyniatpedplSictaantte.s Icfitaizbeanc?kgr.o..u..n..d...c..h..e..c..k..i..s..r.e..q..u..i.r..e.d..,..i.t..w...i.l.l..b..e...a..t..t.h..e...a..p..p..l.i.c..a.n..t.'..s..e..x..p..e..n..s.e.................................. Yes ____ No ____ If the answer is no, the following applies to you.

ANcroerdneecynitotiizuaelnams UaoyfntbihteeeidUssSnuitetadedtoeSrstrcaetiietsisszuaeernde?.reTq.hu..ei.r.eO..d.k..tl.oa.h..so.u.m.b.m.a..it.te..ad..co.h.c.iu.n.m.g..ec..nr.et.a.d.t.ei.on..nt.i.a.p.lr..om.v.a.i.yn..g.b..el.a.iw.s..sf.uu..el.d.p./.rr.ee.s.i.es.sn..uc.e.e.d.w..f.io.t.rh..n.t.ho.e..l.oa.n.p.gp..el.i.rc..ta.ht.ia.o.n.n..t.hb..ee.f.v.o.ar..el.i.da.i.nt.y.O. Yokfleatshhe_om_d_oac_tueNmacoehni_tna_gt_io_n Ipfrothveinagnslawwefruilspnroe,stehnecefo. llIofwthinegdaopcpulmieesnttoatyioonu.proving lawful presence does not have an expiration date that affects the duration of a noncitizen's Nlaownfcuiltipzreenssenocfet,hteheUnntihteedteSatactheisngarcerreedqeunitrieadl sthoaslul bhmaviet dthoecusmamenetavtailoindiptyropveirnigodlaawsftuhleptreeascehnicnegwcritehdethnetialpopflicaaUtio.Sn. bceitfiozreen.an Oklahoma teaching

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Falsification of any information pertaining to certification can result in denial, Signature of Applicanwt _it_h_d_r_a_w_a_l_,_o_r_r_e_v_o_c_a_t_io_n__o_f_t_h_e_O__k_la_h_o_m__a__te_a_c_h_i_n_g_c_reDdaetnet_ia_l_._________________

Signature of Applicant _____________________________________________ Date ____________________

?

?

IMPORTANT

Application will not be processed? if not signed and dat?ed IN THE PRESENCE OF a Notary!

IMPORTANT

Application will not be processed if not signed and dated IN THE PRESENCE OF a Notary!

REVISERDeJvAisNedUAARprYil22001185

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