Request for Initial Teacher Certification



Request for Provisional (Initial) Teacher Certification

Teacher Education Department, Adrian College

Full name: _______________________________________________ (Maiden name: ________________________)

Date of birth ______________________ Social security #: _________________________________

Race (optional) Native American White Black Asian Hispanic Multiracial

I have completed and attached the Rule 101.1 Statement

I have attached an original copy of my First Aid/CPR (adult & child) certificate, which expires on ________

I completed the college’s requirements for certification within the past five years, or

If more than 5 years, I met with the Certification Officer to confirm that I meet current program standards.

Certificate level:

Elementary - I passed the MTTC Elementary Education test (#83) on _____________

Secondary K-12 Art/Music/PE/French/German/Spanish

(PE and Languages are K12 if completed as majors and associate teaching included dual placements)

I have passed the MTTC tests (within the past 5 years) and request the following endorsements:

Secondary candidates MUST request endorsement in their major and MAY also request endorsement in their minor(s). Elementary candidates MAY request endorsements for which they have completed a major or minor.

| PR Academic Study of Religions |No MTTC test |

| YF Bilingual Education/Spanish |MTTC #70 date passed: ___________________ |

| DA Biology |MTTC #17 date passed: ___________________ |

| GH Business Administration |MTTC #34 date passed: ___________________ |

| DC Chemistry |MTTC #18 date passed: ___________________ |

| BD Communication Arts & Sciences (speech) |MTTC #04 date passed: ___________________ |

| ZA Early Childhood Education |MTTC #82 date passed: ___________________ |

| DH Earth/Space Science (not for elementary after Jul 08) |MTTC #20 date passed: ___________________ |

| CA Economics |MTTC #07 date passed: ___________________ |

| BA English |MTTC #02 date passed: ___________________ |

| FA French - K12? Yes No |MTTC #23 date passed: ___________________ |

| FB German - K12? Yes No |MTTC #24 date passed: ___________________ |

| MX Health, PE & Rec (discontinued after July 2010) |MTTC #42 date passed: ___________________ |

|- K12? Yes No | |

| CC History |MTTC #09 date passed: ___________________ |

| DI Integrated Science (elementary) |MTTC #93 date passed: ___________________ |

| DI Integrated Science (secondary) |MTTC #94 date passed: ___________________ |

| EX Mathematics (secondary) |MTTC #22 date passed: ___________________ |

| EX Mathematics (elementary) |MTTC #89 date passed: ___________________ |

| JQ Music (must complete 63 credit major) |MTTC #39 date passed: ___________________ |

| JX Music Education (discontinued after ’00 catalog) |MTTC #39 date passed: ___________________ |

| MB Physical Ed - K12? Yes No |MTTC #44 date passed: ___________________ |

| CD Political Science |MTTC #10 date passed: ___________________ |

| CE Psychology |MTTC #11 date passed: ___________________ |

| DP Physical Science |MTTC #97 date passed: ___________________ |

| DX Science (Natural Science major/minor - ends Jun 08) |MTTC #16 date passed: ___________________ |

| RX Social Studies (not available for secondary minor) |MTTC #84 date passed: ___________________ |

| CF Sociology |MTTC #12 date passed: ___________________ |

| FF Spanish - K12? Yes No |MTTC #28 date passed: ___________________ |

| LQ Visual Arts Education |MTTC #95 date passed: ___________________ |

I request that Adrian’s Certification Officer send my recommendation for provisional certification to the MDE.

Signature: __________________________________________ Date: ______________

Address where bill and certificate are to be mailed: (please print legibly!)

Street/PO Box: _________________________________________City: __________________________ State: ______ Zip: ___________

Contact information after graduation: Email ________________________________________ Phone _____________________________

Office use only: Program completion & degree confirmed by ______________ GPA reqs confirmed by ___________

MTTC tests confirmed by ____________ Rule 101.1 Statement checked by _____________

CPR/1st aid cert confirmed by __________ Recommendation submitted by _______________________ on ___________

APPLYING FOR A MICHIGAN CERTIFICATE

Adrian College, Adrian, MI

Procedure for Securing Your State Teaching Certificate

1. Pass all required certification tests and complete all requirements for graduation/program completion. Also complete First Aid/CPR training from American Red Cross or the American Heart Association.

Note: The November 2006 revision of Michigan Administrative Rules stipulates that the recommendation must be submitted within 5 years of program completion, and MTTC scores more than 5 years old cannot be accepted. If you finished Adrian’s requirements more than five years ago, you must meet with the Certification Officer to confirm that you meet the college’s and State’s current program requirements.

2. Complete and submit the attached “Request for Certification” and the “Rule 101.1 Statement.” The college’s Certification Officer will verify with the Registrar that you completed all requirements. Note: If you list any felonies or more than one misdemeanor, it is strongly recommended that you attach copies of all court “Judgments of Sentence” or “Registers of Actions,” showing how convictions were settled. The Certification Officer will forward these to the MDE with your recommendation, helping speed up your approval.

3. The Certification Officer will submit your recommendation to Michigan's Department of Education and, at the same time, send you a letter verifying that your recommendation has been submitted. This letter serves as a 90-day temporary teaching certificate. (Note: MDE regulations state that if you list any felonies or more than a single misdemeanor on Rule 101.1, the college may not provide you with a 90-day letter.)

4. The MDE will then send you a bill for the certification fees ($125.00) and list your certificate as “pending” on its Certification Verification website (). After you pay the fee to the state, your Teaching Certificate will be mailed to you and the certificate number will be added to the Verification site.

Standards/Requirements for Submitting an Application

A. Passing Scores on the Michigan Tests for Teacher Certification (MTTC)

Prior to recommendation for certification to Michigan or any other state, elementary education candidates must achieve a passing score on the MTTC Elementary Education exam. Evidence of current certification in First Aid and CPR (adult and child) is also required. To add endorsements (for the Early Childhood endorsement or to teach grades 6-8 in your major/minor areas), you must also pass the appropriate MTTC subject area test(s).

Secondary education candidates must passing the MTTC content area test in the major. As of November 2006, passing scores on minor area tests are no longer required, as endorsement in the minor is now an option rather than a requirement. (Please note: Choosing to be certified only in the major may limit opportunities for employment!) Evidence of current certification in First Aid and CPR (adult and child) is also required.

B. State Administrative Rule 101.1

Candidates should be aware that certification may be refused or revoked by the State if it is found that they have committed fraud or misrepresentation in the process of seeking certification, or if they have been convicted of an act of immoral conduct or of a felony or misdemeanor involving moral turpitude. Candidates should be also aware that Michigan schools are now required to review and acknowledge any felony convictions as teachers are hired.

Certificate Renewal

Your first teaching certificate (the “Provisional Certificate) is good for six years, by which time you must apply for a "Professional Certificate.” It requires that the following:

• Eighteen credits in a planned course of study at an approved teacher preparation institution, completed after receiving your Provisional Certificate. Although a master’s degree is strongly encouraged, the 18 credits can be in undergraduate courses. This certificate must be requested by the college or university at which you earn the 18 credits. [After July 2007, eligibility requirements include a 3-credit course in the diagnosis and remediation of reading disabilities and differentiated instruction. Please note that Adrian College’s undergraduate reading courses - TED365/366 and TED 346 - do not currently meet this requirement.]

• Three years of successful teaching since receiving your Provisional Certificate, either as a regular or substitute teacher. A “year” is considered to be 150 days or more in either a calendar or an academic year. A “day” is ½ or more of a teaching day. Days teaching outside of your certification area may not be counted.

Becoming Certified in Other States

Certification requirements differ from state to state. We strongly encourage all graduates to secure a Michigan certificate. Reciprocity agreements between states typically make this the simplest process for being certified elsewhere. Requirements for all 50 states can be found at uky.edu/Education/TEP/usacert.html.

State of Michigan Rule 101.1

Teaching Certificate Denial/Revocation Standards

Adrian College, Adrian, MI

Rule 101.1 of the Administrative Rules Governing the Certification of Michigan Teachers describes the State Board of Education’s authority to deny, suspend or revoke a teaching certificate. Reasons for doing so include conviction for certain misdemeanors and felonies. Michigan’s “School Safety” legislation (2005 PA 129-131 and 138) states that a person convicted of a ‘listed’ crime (those requiring a person to be listed on the ‘sex offender registry’) cannot be certified or work in any school. It also requires that, if you have any felony conviction, it must be reported to the school when applying for a job, and that you can be hired only if the superintendent and school board agree in writing to do so in spite of the conviction.

Fraud, misrepresentation, or concealment when applying for a certificate are also reasons that a certificate may be denied, suspended or revoked.

When Adrian College submits your “Recommendation for Certification” to the Michigan Dept of Education (MDE), if you have more than a single misdemeanor conviction, the certification officer is required to attach that information to the Recommendation and cannot provide you with the standard “90-Day Letter of Certification.” To expedite the review of your Recommendation, the MDE asks (but does not require) that the college attach copies of all court “Judgments of Sentence” or “Registers of Actions,” showing how your convictions were settled.

To ensure that our teacher candidates are aware of these rules and adequately counseled regarding possible results of convictions, they are asked to complete and sign this Statement at various times throughout the program.

Name __________________________________ Social security number: ___________________

No Yes Have you ever been convicted (by verdict, plea of guilty, or plea of nolo contendere) of a felony?

No Yes Have you ever been convicted of a misdemeanor as an adult?

No Yes Have you ever been convicted or received a suspended sentence for a crime or an attempt to commit a crime which is considered sexually related?

No Yes Do you have any charges or warrants of arrest pending against you?

No Yes Have you ever had a teaching credential suspended, revoked, nullified, or otherwise invalidated?

If you answered “yes” to any question, list the date(s) and describe the nature of the conviction(s):

|Date |Nature of conviction | |

| | |

|I affirm, under the penalty of committing fraud in the application process, that the statements made above are true, complete and |

|correct. I also affirm that I will report to the Teacher Education Department chair, in writing, any conviction or charges that arise |

|after I submit this form. I understand that convictions will be reviewed by the MDE when my recommendation for a teaching certificate |

|is submitted and that they may impact my opportunities to find employment. |

| |

|___________________________________________ __________________ |

|signature date |

To expedite the MDE’s review of your recommendation, you are asked to provide the college’s Certification Officer with copies of the court’s “Judgment of Sentence” or “Register of Actions” showing how convictions were settled.

Note: Signed 101.1 Statements are kept in the candidate’s Teacher Education Department file. As required by the Buckley Amendment, such student records are confidential and can be reviewed only by individuals authorized by the Teacher Education Department chair.

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