College of Education



Licensure Request Form 2017-18* = Response is requiredPersonal Information - *Name to appear on teaching licensePlease type your name as you wish it to appear on your teaching licenseClick or tap here to enter text.*Previous name(s)I.e., maiden/married nameClick or tap here to enter text.*Social Security Number (xxx-xx-xxxx)Click or tap here to enter text.*Birth date (xx/xx/xxxx)Click or tap here to enter text.*Non-OSU email addressWe cannot accept your OSU email for your licensure request because this email will expire. Click or tap here to enter text.Degrees - *Bachelor’s Degree Information - *Degree date: Click or tap here to enter text.*Institution: Click or tap here to enter text.*Major and degree awarded (if you are completing the Double Degree program, please be sure to enter both your primary major and your education major)Major/Minor/Option (i.e., HDFS, Biology, etc.): Click or tap here to enter text.Degree (i.e., Bachelor of Science): Click or tap here to enter text. Master’s Degree Information - Degree date: Click or tap here to enter text.Institution: Click or tap here to enter text.Major and degree awardedMajor/Minor/Option (i.e., Ag Education): Click or tap here to enter text.Degree (i.e., Master of Science): Click or tap here to enter text. Doctoral Degree Information - Degree date: Click or tap here to enter text.Institution: Click or tap here to enter text.Major and degree awardedMajor/Minor/Option: Click or tap here to enter text.Degree: Click or tap here to enter text. *Endorsement Area(s) - Please note, this includes the endorsement for your preliminary license as well as any additional endorsement(s) you may be adding? Agriculture? Biology? Career and Technical Education (CTE)? Chemistry? ESOL? Family and Consumer Sciences (FACS)? Health? Integrated Science? Language Arts? Mathematics, Advanced? Mathematics, Basic? Multiple Subjects Self-Contained? Music? PE? PE, Adaptive? Physics? Social Studies? School Counseling? Spanish*Additional information - *Mailing addressPlease enter the mailing address at which we can reach you with questions about your request. Click or tap here to enter text.*Phone numberPlease enter the number by which we can reach you with questions regarding this requestClick or tap here to enter text. ................
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