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APPLICATION INSTRUCTIONS
                                                         INITIAL CERTIFICATION
                                                                                                                                 Page 1 of 18



PERSONAL INFORMATION
Enter all personal information in the spaces provided, including contact phone number(s) and email address.
The address entered will be the address that your certificate will be mailed. It is the responsibility of the applicant to maintain current
information, including name and mailing address, on file with the Teacher Certification office.


BACKGROUND INFORMATION
Answer “yes” or “no” to questions one through six (1-6) as they apply to you. If the answer to any of these questions is “yes,” please
provide a written, detailed explanation of the incident and sign it. It is not necessary to provide a written explanation of a minor traffic
violation. Include a written explanation of incidences involving Driving While Intoxicated (DWI) or Driving Under the Influence (DUI).
 If no written explanation is provided for any “yes” answers to questions one through six (1-6), the application will be
returned.
If you answer “yes” to question seven (7), list the state(s) where you hold/held teaching certificates and the expiration date(s).


ETHNICITY
Check the box that most appropriately applies to you. Definitions for each choice are provided.


CERTIFICATION SELECTION & REQUIREMENTS
Use the lists of requirements under each Initial certificate type to determine if you qualify for an Initial certificate. Check the box next to
the type of Initial certificate for which you are applying.

RECORD OF TRAINING
List all colleges/universities you attended to complete your degree(s) and approved teacher preparation program(s). You must include all
college coursework, including community college or transfer credits. Your official transcripts must show the completion of at least a
bachelor’s degree from a regionally accredited university to qualify for Alaska teacher certification. If you completed your degree outside
of the United States, a complete, original foreign evaluation must be submitted with your application.
If you have completed the required Alaska Multicultural or the required Alaska Studies coursework, please provided the requested
information. If you have not completed the required coursework, indicate the courses you plan to take and the anticipated dates of
completion.

Official transcripts for all institutions listed in this section must be included with the application or on file with the Teacher Certification
office. Do not request universities to submit transcripts directly to the Teacher Certification office. We encourage you to open the sealed
transcripts when they arrive to verify the correct coursework and/or degree(s) are posted. We accept official transcripts after they have
been opened, provided the transcripts bear the registrar’s signature/seal and are printed on official university transcript paper. Unofficial
transcripts, electronic transcripts, or photocopies will not be accepted.


BASIC COMPETENCY EXAM
Indicate the approved Basic Competency Exam (BCE) that you have passed or indicate the date that you are scheduled to take an
approved BCE.
If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Educational Testing Services (ETS),
or you can include an original/official examinee score report with your application. To contact ETS, visit www.ets.org.
If you have the scores sent directly from ETS, email the Teacher Certification office at tcwebmail@alaska.gov to verify that passing Praxis
I scores are on file BEFORE sending the application. The application will be returned if it is submitted before passing Praxis I scores have
been received in the Teacher Certification office.
For all other approved basic competency exams, an original/official examinee score report showing passing scores on all three sections
of the exam must be included with the application. More information concerning approved exams is available on our website at
http://www.eed.state.ak.us/teachercertification/praxis.html.


PREVIOUS ALASKA CERTIFICATION & AUTHORIZATIONS
Indicate the statements that describe your previous Alaska certification status. If applicable, provide the requested information
concerning your previous Alaska certifications or authorizations.

REQUESTED ENDORSEMENTS
Endorsements will only be granted if they have been requested in this section of the application. List all teaching endorsements that you
are requesting to be on your Initial teacher certificate. When requesting endorsements, please indicate content area and grade levels if
applicable.
Requesting an endorsement does not guarantee that the endorsement area will be granted. Endorsements will only be granted based on
Alaska’s endorsement requirements.
If you are applying using a current, valid out-of-state certificate, the endorsements on your Initial Alaska teacher certificate will
reflect those endorsements listed on your current, valid out-of-state certificates that correspond to the endorsements on the List of
Endorsements on page 12. If the applicant holds more than one current, valid out-of-state certificate, the applicant must choose which
out-of-state certificate to submit with the Initial application.
If the requested endorsement section is left blank, the application will be returned.

                       Department of Education & Early Development, Teacher Education and Certification
                              801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                             Phone: (907) 465-2831 Fax: (907) 465-2441
Initial               www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                             11/17/11
APPLICATION INSTRUCTIONS
                                                         INITIAL CERTIFICATION
                                                                                                                                Page 2 of 18




FINGERPRINT CARD CHECKLISTS
One (1) complete fingerprint card is a requirement for all applicants for Initial certification, with a few exceptions. If you need a
fingerprint card, email the Teacher Certification office at tcwebmail@alaska.gov and request that a card be sent to you. You must have
your fingerprints rolled by a trained technician. The technician must sign and date the card in the appropriate space. All personal
information must be filled in, including signature, residence, citizenship, sex, height, weight, race, eye color, hair color, date of birth, and
place of birth.
If you held an Alaska Student Teacher Authorization which expired less than 60 days prior to the date your Initial teacher certification
application is received by the Teacher Certification office and your background clearance was completed less than 18 months from the
date of application, you do not need to submit a fingerprint card with your Initial application. Email the Teacher Certification office at
tcwebmail@alaska.govv to determine if your previous background clearance can be used for this application.

If you have submitted a fingerprint card for a background check to the Teacher Certification office in the previous six months, email the
Teacher Certification office at tcwebmail@alaska.gov to determine if your previous background check can be used for this application.


FEE SCHEDULE
The application fee for the Initial certificate is $125.00. The fingerprint processing fee is an additional $66.00. All applicants for the
Initial certificate must include payment in the form of a cashier’s check, money order, credit card or debit card. Fees are non-
refundable. No personal checks will be accepted.
If paying by credit or debit card, complete all information in this section, including the name on the card and the cardholder’s signature.
Cashier’s checks or money orders can be made payable to the Alaska Department of Education & Early Development (EED).


REQUIREMENT CHECKLISTS
Review your application before submitting it to the Teacher Certification office. You must include all the items on the checklists that apply
to the type of Initial teacher certificate for which you are applying. If any of the required documents listed on the applicable checklists
are not included with the application, the entire application will be returned.
You must have completed all requirements listed in this section in order to qualify for Initial certification. If you have not met all of the
requirements listed in this section, the application will be returned. If you have questions about the requirements, please email the
Teacher Certification office at tcwebmail@alaska.gov.

IMPORTANT NOTES
Read the important notes that are associated with the type of Initial teacher certificate for which you are applying. When you sign the
notarization section, you will attest that you understand the requirements that still need to be met to maintain your Initial teacher
certificate and to qualify for a Professional teacher certificate. See page 10 of the application for a list of requirements for Professional
teacher certification.

NOTARIZATION
The application must be signed and dated by the applicant in the presence of a Notary Public or Postmaster.
The application must be notarized by a certified Notary Public. If a Notary Public is not available to you, a Postmaster may sign, date,
and stamp this affidavit.
If any portion of this section is incomplete, the application will be returned.

RECOMMENDATIONS & PROOF OF PROGRAM ENROLLMENT
You must submit an Institutional Recommendation, a State Recommendation, or a Proof of Program Enrollment form with this application
or have one on file with the Teacher Certification office. These forms are located on pages 13-18. Use only the form that applies to your
situation.
The appropriate form must first be sent to the university or state agency where you completed or are enrolled in an approved teacher
preparation program. More detailed directions on the completion of these forms can be found on page 11.
NOTE: Proof of Program Enrollment cannot be used for individuals enrolled in special education programs. Those individuals must
complete their program prior to applying for the Initial certificate.
Applicants that are applying for an Initial/Out-of-State certificate have one year for the issue date of their certificate to submit an
Institutional Recommendation, a State Recommendation, or a Proof of Program Enrollment form to our office.

MAIL YOUR APPLICATION
The application and supporting documents must be mailed to the Teacher Certification office at the following address:

                               Department of Education & Early Development
                               Teacher Education & Certification
                               801 West 10th Street, Suite 200
                               PO Box 110500
                               Juneau, AK 99811-0500
If you would like your original documents (i.e. Out-of-State certificate, original score report) to be returned, you must include a self-
addressed, stamped envelope with your application packet.

                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                              11/17/11
TEACHER CERTIFICATION APPLICATION
                                              INITIAL CERTIFICATION
                                                                                                                          Page 3 of 18


PERSONAL INFORMATION


LAST NAME                           FIRST NAME                           M.I.              SOCIAL SECURITY NUMBER




MAILING ADDRESS                                                        CITY                        STATE         ZIP CODE



HOME PHONE NUMBER                                      WORK OR MOBILE PHONE NUMBER                                  GENDER



HOME EMAIL ADDRESS


            -              -
BIRTHDATE (MM-DD-YYYY)                                 FORMER LAST NAME(S)                         HIGHEST EDUCATIONAL DEGREE

It is the responsibility of the applicant to maintain current information, including name and mailing address, on file with
the Teacher Certification office. All name changes must be supported with a photocopy of the legal document verifying the
change.



BACKGROUND INFORMATION
Answer the following questions carefully and completely. If you answer “yes” to any of the questions 1-6, provide a detailed statement in
the box below or on a separate sheet of paper. Any falsification or deliberate misrepresentation, including omission of a
material fact, in completion of this application can be grounds for denial of certification.


YES NO            1.   Have you been convicted for a violation of criminal law, except for minor traffic violations? Please
                         include convictions for Driving While Intoxicated (DWI) and Driving Under the Influence (DUI).

YES NO            2.   Do you currently have any outstanding criminal charges or warrants of arrest pending against
                         you? This would include any state, province, territory, and/or country.

YES NO            3.   Is there action pending to revoke or suspend a certificate or license issued to you by another
                         jurisdiction? If “yes,” on a separate sheet of paper, list the agency, including complete address
                         and telephone number as well as the purpose of the investigation or inquiry.

YES NO            4.   Have you ever had any adverse action taken on any certificate or license? (Adverse action
                         includes letters of warning, reprimands, suspensions, revocations, voluntarily surrenders, or
                         voidance)

YES NO            5.   Are you currently or have you ever been the subject of any certificate or licensing investigation or
                         inquiry by any certification or licensing agency for allegations of misconduct? If “yes,” on a
                         separate sheet of paper, list the agency, including complete address and telephone number as
                         well as the purpose of the investigation or inquiry.

YES NO            6.   Have you ever been denied certification? This would include any state, province, territory, and/or
                         country.
If you answered “yes” to any of the questions above (1-6), provide a detailed statement here. If you need
additional spaces, provide the detailed statement on a separate sheet of paper and sign it.




YES NO           7. Have you ever held a teaching certificate in another state? If yes, please complete the following.

 STATE                         EXPIRES:                                   STATE                         EXPIRES

 YES NO          8. Are you currently under contract or have been offered a contract with a public school district in
                      Alaska? If yes, please complete the following.

     Alaska public school district: _________________________________, beginning contract date: _______________



                     Department of Education & Early Development, Teacher Education and Certification
                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                         11/17/11
TEACHER CERTIFICATION APPLICATION
                                             INITIAL CERTIFICATION
                                                                                                                           Page 4 of 18

ETHNICITY
                            Alaska Native: Any person having origins in any of the original peoples of Alaska, and who maintains
 Alaska Native                    cultural identification through tribal affiliation or community recognition. This may include, for
 Asian or Pacific                 example, any person of Yup’ik, Inupiat, Aleut, Athabascan, Tlingit, Haida, or Tsimshian origin.
      Islander
                            Asian or Pacific Islander: Any person having origins in any of the original peoples of the Far East, Southeast
 African American                 Asia, the Indian Subcontinent, or the Pacific Islands. This includes, for example, China, Japan,
 Hispanic                         Korea, the Philippine Islands and Samoa.

 Caucasian                 African American: (Not of Hispanic origin); any person having origins in any of the Black racial groups of
 American Indian/                  Africa.
      Native American
                            Hispanic: Any person of Mexican, Puerto Rican, Cuban, Central American, or other Spanish culture or origin,
 Other                            regardless of race

                            Caucasian: (Not of Hispanic origin); any person having origins in any of the original peoples of Europe,
                                   North Africa, or the Middle East.

                            American Indian/Native American: Any person having origins in any of the original peoples of North
                                   America (not including Alaska), and who maintains cultural identification through tribal affiliation or
                                   community recognition.




CERTIFICATE SELECTION & REQUIREMENTS
Use the lists of requirements under each certificate type to determine if you qualify for an Initial
certificate. Check the box next the type of Initial certificate for which you are applying.


 INITIAL/2-YEAR                                                        INITIAL/3-YEAR
     Passing scores on an approved Basic                                 Passing     scores on an approved Basic
      Competency Exam                                                      Competency Exam
     Completed state-approved teacher preparation                        Completed state-approved teacher preparation
      program                                                              program
     Never held an Initial or Provisional Alaska                         Never held an Initial or Provisional Alaska
      teacher certificate                                                  teacher certificate
      -and-                                                                -and-
      Not eligible for reinstatement of a Professional                    Not eligible for the reinstatement of a
      or Master teacher certificate.                                       Professional or Master teacher certificate.
                                                                          Official transcripts showing:
 INITIAL/OUT-OF-STATE (1-YEAR)                                           o 3 semester hours of approved Alaska Studies
                                                                            coursework
     Has never held Alaska teacher certification                         o 3 semester hours of approved Alaska
     Holds current, valid out-of-state certificate at                      Multicultural coursework
      the time of Initial application
     The out-of-state certificate will be current and
                                                                      INITIAL/PROGRAM ENROLLMENT
      valid at the time the applicant’s contract for
                                                                           (1-Year)
      instructional services begins in an Alaska
      public school district                                              Has never held Alaska teacher certification
 INITIAL/REEMPLOYMENT (1-YEAR)                                           Passing scores on an approved Basic
                                                                           Competency Exam
     Has never held an Alaska Reemployment                               Currently enrolled in a state-approved teacher
      teacher certificate                                                  preparation program
     Held an Alaska teacher certificate that was                         NOTE: Individuals enrolled in a Special
      valid for at least two years                                         Education teacher preparation program is not
     The most recent Alaska teacher certificate                           eligible for an Initial teacher certificate using
      must have expired more than a year prior to                          Program Enrollment
      the date of application.




                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                        11/17/11
TEACHER CERTIFICATION APPLICATION
                                             INITIAL CERTIFICATION
                                                                                                                    Page 5 of 18



RECORD OF TRAINING
Official transcripts of all academic work completed must be included with the application or be on file with our office.
Your official transcripts must show the completion of at least a bachelor’s degree from a regionally accredited university
to qualify for Alaska teacher certification. If you completed your degree outside of the United States, a complete,
original foreign evaluation must be submitted with your application. Official transcripts may be opened, but not marked
on in any way. Unofficial, photocopied, electronic or faxed transcripts or evaluations will not be accepted.
     DEGREE(S)                                                                                                             YEARS
                               COLLEGE OR UNIVERSITY               CITY, STATE               MAJOR/PROGRAM
      EARNED                                                                                                             ATTENDED




Indicate the college or university where you have met or plan to meet following coursework requirements.
                        REQUIREMENTS                           COLLEGE OR UNIVERSITY              COURSE      DATE OR ANTICIPATED
                                                                                                 NUMBER(S)    DATE OF COMPLETION
 Three (3) semester hours of APPROVED Alaska Studies
 coursework
 Three (3) semester hours of APPROVED
 Multicultural/Cross-cultural Communications coursework



BASIC COMPETENCY EXAM
Indicate the approved basic competency exam (BCE) that you have passed or indicate the date that you are scheduled
to take one of the approved BCE.

         California Basic             Florida Teacher                Michigan Test for              Oklahoma General
          Educational Skills            Certification Exam              Teacher Certification           Education Test
          Test (C-BEST)                                                 (MTTC)                          (OGET)

         Washington Educator          Georgia Assessment             New Mexico                     New York State
          Skills Test-Basic             for the Certification of        Assessment of                   Teacher Certification
          (WEST-B)                      Teachers                        Teacher Basic Skills            Liberal Arts and
                                                                                                        Sciences Test
         Praxis I (Math,              Alabama Work Keys              Illinois Certification
          Reading & Writing)                                            Testing System

         I am scheduled to take an approved basic competency exam on _________________________.

If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Educational Testing
Services (ETS), or you can include an original/official examinee score report with your application. To contact ETS,
visit www.ets.org. If you have had the scores sent directly from ETS, email the Teacher Certification office at
tcwebmail@alaska.gov to verify passing Praxis I scores are on file, BEFORE sending in the application.

For all other approved basic competency exams, an original examinee score report showing passing scores on all three
sections of the exam must be included with the application.

PREVIOUS ALASKA CERTIFICATION & AUTHORIZATIONS
Indicate which statements describe your Alaska certification status. If you have held an Alaska teacher certificate prior
to this application, you will need to verify whether or not you are eligible to apply for an Initial teacher certificate.
Please refer to the Certification Selection & Requirements section of this application for more information.

          I held an Alaska Student Teacher Authorization that expired on ___________________________.

          I have never held an Alaska teacher certificate.

          I have held the following Alaska teacher certificates with the expiration dates indicated below:

            Certificate Type        Expiration Date(s)                 Certificate Type               Expiration Date (s)
            Initial/Sec
nd
                                                                       Provisional/Temporary
            Initial
            Professional/Type A                                        Reemployment



                        Department of Education & Early Development, Teacher Education and Certification
                               801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                              Phone: (907) 465-2831 Fax: (907) 465-2441
Initial                www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov               11/17/11
TEACHER CERTIFICATION APPLICATION
                                           INITIAL CERTIFICATION
                                                                                                             Page 6 of 18

REQUESTED ENDORSEMENTS
List all requested endorsements, content or specialty area(s), and grade levels. Qualifying endorsements will only be
granted if they have been requested in this section of the application. You may only request endorsement areas
found on the “List of Endorsements” located on page 12 of this application.
INITIAL/2-YEAR OR 3-YEAR: Endorsements may be requested based on your Institutional Recommendation; State
Recommendation; and posted degree, major, or minor (of at least 18 semester hours).
In the areas of English, Mathematics, General Science, French, and German, you may also request endorsements based
on passing scores on the required Praxis II exams.
INITIAL/OUT-OF-STATE: Endorsements will only reflect those endorsements listed on the applicant’s current, valid
out-of-state certificates that correspond to the endorsements on the List of Endorsements. If the applicant holds
more than one current, valid out-of-state certificate, the applicant must choose which out-of-state certificate to submit
with the Initial application.
INITIAL/PROGRAM ENROLLMENT: Endorsements will reflect the teacher preparation program described on the Proof
of Program Enrollment form.
INITIAL/REEMPLOYMENT: Endorsements will reflect the endorsements on the applicant’s previous Alaska teacher
certificate.

              CONTENT AREA                 GRADE LEVEL(S)                CONTENT AREA                  GRADE LEVEL(S)


(SAMPLE) ELEMENTARY EDUCATION              ____K-8_____       3. ___________________________             ___________

1. ___________________________             ____________       4. ___________________________             ___________

2. ___________________________             ____________       5. ___________________________             ___________




FINGERPRINT CARD CHECKLIST
If you are required to submit one (1) fingerprint card, Form FD-258 or similar, with your application, please use the
following checklist to make sure that all the required information on the fingerprint card has been completed. If any
section of the fingerprint card is incomplete, the entire application packet will be returned. If you cannot obtain a
fingerprint card locally, email the Teacher Certification office at tcwebmail@alaska.gov to request a card be sent to you.
More information can be found at http://www.eed.state.ak.us/TeacherCertification/fingerprints.html.

                 Fingerprints must be rolled by a trained technician.
                 The technician must sign and date the card in the appropriate space
                 All personal information below must be filled in:
                            signature                 height                   hair color
                            residence                 weight                   date of birth
                            citizenship               race                     place of birth
                            gender                    eye color

Previous Clearance (For Initial Applicants who hold or have held a Student Teacher Authorization)
If you held an Alaska Student Teacher Authorization that expires less than 60 days prior to the date your application is
received by the Teacher Certification office, and your background clearance was completed less than 18 months from
the date of application, you do not need to submit a fingerprint card with your Initial application. Email the Teacher
Certification office at tcwebmail@alaska.gov to determine if your previous background clearance can be used for your
Initial teacher application.




                    Department of Education & Early Development, Teacher Education and Certification
                           801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                          Phone: (907) 465-2831 Fax: (907) 465-2441
Initial            www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov             11/17/11
TEACHER CERTIFICATION APPLICATION
                                                         INITIAL CERTIFICATION
                                                                                                                               Page 7 of 18



 FEE SCHEDULE
 The application fee is $125.00. The fingerprint processing fee is $66.00. If you require a fingerprint card, submit a
 total of $191.00. You may pay with a cashier’s check (payable to EED), money order, credit card or debit card (Visa,
 Discovery or MasterCard). Fees are non-refundable. Personal checks will not be accepted.

                                  0       0
                              .
 AMOUNT

                                      -                   -                     -                                        /
 CREDIT CARD NUMBER                                                                                           EXPIRATION DATE (MM/YY)



 NAME ON CREDIT CARD                                                           CARDHOLDER’S SIGNATURE


 REQUIREMENT CHECKLISTS
 You must include all of the items required for the certificate for which you are applying in a single application packet. If
 any item is missing, the entire application packet will be returned unprocessed. Mark the checkbox next to each
 requirement to indicate the item is included in your application packet or on file with the Teacher Certification office.
 Photocopied/faxed applications will not be accepted.

                         ALL INITIAL APPLICANTS

                            Complete Initial Application (pages 3 -10)
                             Make sure all sections of the application are complete. If any section is incomplete, all documents will be
                             returned. The application must be mailed to the Teacher Certification office at the address below.

                            Official transcripts verifying a Bachelor’s Degree or Higher, from a regionally accredited
                             institution (page 5)
                             Official transcripts reflecting all coursework and degree(s) must be included with the application or on file
                             with the Teacher Certification Office, including community college and/or transfer credit. Unofficial,
                             photocopied, faxed, or electronic transcripts will not be accepted. If you completed your degree outside of
                             the United States, a complete, original foreign evaluation must be submitted with your application. Official
                             transcripts or original foreign evaluation may be opened, but not marked on in any way.
ALL INITIAL APPLICANTS




                            Fingerprint Card (page 6)
                             You are required to submit one (1) FBI Applicant fingerprint card (Form FD-258). If you cannot obtain the
                             fingerprint card locally, email the Teacher Certification office to request a card be sent to you. Use the
                             Fingerprint Card Checklist to make sure that all required items have been completed. If any section of
                             the fingerprint card is incomplete, the entire application packet will be returned.
                               -OR-

                             Previous Clearance (For Initial Applicants who held or hold a Student Teacher Authorization)
                             If you held an Alaska Student Teacher Authorization which expired less than 60 days prior to the date your
                             application is received by the Teacher Certification office and your background clearance was completed
                             less than 18 months from the date of application, you do not need to submit a fingerprint card with your
                             Initial application. Email the Teacher Certification office at tcwebmail@alaska.gov to determine if your
                             previous background clearance can be used for your Initial teacher application.

                            Application Fees (page 7)
                             The application fee for an Initial certificate is $125.00. The fingerprint processing fee is $66.00. Submit a
                             total fee of $191.00. Fees are non-refundable. You may pay with a cashier’s check, money order, or credit
                             or debit card. No personal checks will be accepted.

                            Signature and Notarization (page 9)
                             The “Notarization” section of the application must be completed. A Notary Public or a Postmaster must
                             witness and verify your signature with a signature and stamp/seal.


                                          REQUIREMENT CHECKLISTS CONTINUES ON THE NEXT PAGE




                                   Department of Education & Early Development, Teacher Education and Certification
                                          801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                                         Phone: (907) 465-2831 Fax: (907) 465-2441
 Initial                          www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                11/17/11
TEACHER CERTIFICATION APPLICATION
                                                           INITIAL CERTIFICATION
                                                                                                                                Page 8 of 18


REQUIREMENT CHECKLISTS (continued)
                          INITIAL/2-YEAR & 3-YEAR

                               Passing Scores on an approved Basic Competency Exam (BCE) (page 5)
                                If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from
                                Educational Testing Service (ETS), or you can include an original examinee score report with your
                                application. To contact ETS, visit www.ets.org. Email the Teacher Certification office to verify passing
Initial/2-year & 3-year




                                Praxis I scores are on file, BEFORE sending in the application. For all other approved basic competency
                                exams, an original examinee score report must be included with the application. Photocopies of
                                reports will not be accepted.
                                -AND-
                               Institutional Recommendation verifying the completion of an approved Teacher Education
                                Program Offered by a regionally accredited institution (pages 13-14)
                                The preparing institution must complete the Institutional Recommendation (IR) form. The original form
                                must be included with the application. Photocopies/faxes will not be accepted.
                                –OR-
                                State Recommendation verifying the completion of a state Approved Teacher Preparation
                                Program (pages 17-18)
                                The preparing State must complete the State Recommendation form. The original form must be
                                included with the application. Photocopies/faxes will not be accepted.
                                –OR-
                                Foreign Evaluation verifying the completion of a teacher preparation outside of the United
                                States (See http://www.eed.state.ak.us/teachercertification/forms/Foreign_Evaluation_Info.pdf)

                          INITIAL/3-YEAR
Initial/3-yr.




                               Official transcripts verifying the completion of 3 semester hours of approved Alaska Studies
                                and 3 semester hours of approved Alaska Multicultural coursework (page 5)
                                Official transcripts reflecting all the required coursework must be included with the application or on file
                                with the Teacher Certification Office. Unofficial, photocopied, faxed, or electronic transcripts will not be
                                accepted. Official transcripts may be opened, but not marked on in any way.

                          INITIAL/OUT-OF-STATE (OOS)
Initial/OOS




                             Current, valid teaching certificate issued by another state (page 3)
                              One official, original certificate or a duplicate certificate issued directly from that state’s Department of
                              Education must be included. Photocopies will not be accepted. If the state’s Department of Education
                              that issued your current, valid Out-of-State certificate only provides electronic copies of certificates, send a
                              printout of the certificate from the website and provide the web address where our office can verify the
                              status of your Out-of-State certificate.

                          INITIAL/PROGRAM ENROLLMENT
                             Passing scores on an approved Basic Competency Exam (BCE) (page 5)
                              If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from
Initial/Enrollment




                              Educational Testing Service (ETS), or you can include an original examinee score report with your
                              application. To contact ETS, visit www.ets.org. Email the Teacher Certification office to verify passing
                              Praxis I scores are on file, BEFORE sending in the application. For all other approved basic competency
                              exams, an original examinee score report must be included with the application. Photocopies of reports
                              will not be accepted.
                             Proof of Program Enrollment in an approved Teacher Education Program (page 15-16)
                               The regionally accredited university offering the approved teacher education program must complete the
                               Proof of Program Enrollment form. The original Proof of Program Enrollment form must be included with
                               this application. NOTE: This form cannot be used for individuals enrolled in special education programs.
                               Those individuals must complete their program prior to applying for the Initial certificate.
                               Photocopies/faxes will not be accepted.

                          INITIAL/REEMPLOYMENT (REEMPLOY)
Initial/REEMPLOY




                             Previous Alaska Certificate that has been expired for longer than one year (page 5)
                               A copy of the expired certificate must be included with the application or on file with the Teacher
                               Certification office.
                               NOTE: If you choose this option, within one year from the date the application is received by the Teacher
                               Certification office, you must meet all requirements and apply for the Professional certification.


                                     Department of Education & Early Development, Teacher Education and Certification
                                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial                             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov               11/17/11
TEACHER CERTIFICATION APPLICATION
                                               INITIAL CERTIFICATION
                                                                                                                              Page 9 of 18



   IMPORTANT NOTES
INITIAL/2-YEAR (INITIAL/2-YR)
Within two years from the date that your application was received by the Teacher Certification office, official transcripts showing the
completion of 3 semester hours of approved Alaska Studies coursework and 3 semester hours of approved Alaska Multicultural
coursework must be received by the Teacher Certification office. Upon receipt of official transcripts showing completion of this required
coursework, your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and Alaska
Multicultural requirement, your certificate will expire and you will not be eligible to teach in an Alaska public school nor
apply for an additional Alaska teacher certificate.

INITIAL/OUT-OF-STATE (1-year certificate)
Within one year from the date that your application was received by the Teacher Certification office, official passing scores on an
approved Basic Competency Exam and a State or Institutional Recommendation must be received by the Teacher Certification
office from the date your application was received. Upon receipt of an official scores report and your recommendation, your Initial
certificate will be extended for one additional year. If the Teacher Certification office does not receive passing scores and the
recommendation within the first year, your certificate will expire and you will not be eligible to teach in an Alaska public
school.

Within two years from the date that your application was received by the Teacher Certification office, official transcripts showing the
completion of 3 semester hours of approved Alaska Studies coursework and 3 semester hours of approved Alaska Multicultural
coursework must be received by the Teacher Certification office. Upon receipt of official transcripts showing the completion of the
required coursework, your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and
Alaska Multicultural requirement, your certificate will expire and you will not be eligible to teach in an Alaska public school
nor apply for an additional Alaska teacher certificate.

The endorsements on your Initial certificate will be the same as those on the current, valid, out-of-state certificate submitted with your
application packet. If you hold more than one out-of-state certificate, you must choose ONE to submit with your application. When you
apply for Professional Alaska certification, your transcripts, and Institutional Recommendation or State Recommendation will be analyzed
to determine which endorsements will be awarded.

INITIAL/PROGRAM ENROLLMENT (1-year certificate)
Within one year from the date that your application was received by the Teacher Certification office, updated official transcripts and
an updated Proof of Program Enrollment form showing progress toward completion of your teacher preparation program or official,
updated official transcripts and an Institutional Recommendation showing the completion of a teacher preparation program must
be received by the Teacher Certification office. Upon receipt of the transcripts and recommendation or program enrollment form, your
Initial certificate will be extended for one additional year.
Within two years from the date that your application was received by the Teacher Certification office, official transcripts and an
Institutional Recommendation showing the completion of a teacher preparation program must be received by the Teacher
Certification office. In addition, your transcripts must document the completion of 3 semester hours of approved Alaska Studies
coursework and 3 semester hours of approved Alaska Multicultural coursework. Upon receipt of the transcripts and recommendation,
your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and Alaska Multicultural
requirement or do not complete your teacher preparation program, your certificate will expire and you will not be eligible
to teach in an Alaska public school nor apply for an additional Alaska teacher certificate.
The endorsements on your Initial certificate will be the same as those listed on your Proof of Program Enrollment form.

INITIAL/REEMPLOYMENT (1-year certificate)
When your Initial/Reemployment certificate expires, you must meet all requirements for and apply for a Professional or Master teacher
certificate. You will not be eligible for any other Alaska teacher certificate.

The endorsements on your Initial/Reemployment certificate will be the same as those on your most recent Alaska teacher certificate.

NOTARIZATION
                                                                           I have read the IMPORTANT NOTES concerning the Initial
State of                            Date                                   certificate for which I am applying. I understand the
                                               (MONTH/DAY/YEAR)            requirements and timeline to keep my Initial certificate current
                                                                           and qualify for a Professional certificate. If I do not satisfy the
    ______________________             appeared before me whose            requirements, I understand that I will no longer hold Alaska
           (NAME OF APPLICANT)
                                                                           teacher certification and will not be eligible to hold a certified
                                                                           teaching position in an Alaska public school.
identification I have verified on the basis of _____________________
                                                  (TYPE OF PHOTO ID)
                                                                           I certify under penalty of perjury that the statements made by
                                                                           me in this application are true and correct to the best of my
to be the signer of this application and he/she acknowledged that
                                                                           knowledge. Further, I acknowledge that I have read and will
he/she signed it.
                                                                           adhere to the State of Alaska Code of Ethics of the
                                                                           Education Profession. This becomes part of my official
(SIGNATURE OF NOTARY)                                                      record.

My commission expires:
                                                                                              SIGNATURE OF APPLICANT
If a notary is not available, a Postmaster may witness, date
stamp, and sign this affidavit.                                                   _______________________________________
                                                                                                   DATE




                         Department of Education & Early Development, Teacher Education and Certification
                                801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                               Phone: (907) 465-2831 Fax: (907) 465-2441
Initial                 www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                        11/17/11
TEACHER CERTIFICATION APPLICATION
                                       INITIAL CERTIFICATION
                                                                                                     Page 10 of 18

PROFESSIONAL CERTIFICATION REQUIREMENTS
After obtaining an Initial teacher certificate, the next step in Alaska teacher certification is
qualifying for a Professional teacher certificate.

Read the following list and note the requirements that you still need to satisfy to gain a
Professional teacher certificate. If you are currently able to satisfy all of these requirements,
you should apply for a Professional teacher certificate instead of an Initial teacher certificate.

The Professional application is available at
http://www.eed.state.ak.us/teachercertification/forms/profess.pdf.

           Passing scores on an approved Basic Competency Exam (e.g. Praxis I, CBEST, WEST-
              B, etc.)

           An Institutional Recommendation and official transcripts showing the completion of an
             approved teacher preparation program

             -OR-

             A State Recommendation showing the completion of an approved teacher preparation
             program

             -OR-

             A Foreign Evaluation from an approved agency showing the completion of a teacher
             preparation program outside of the United States.

           Official transcripts showing the completion of the following:

                 •   A Bachelor’s degree or higher from a regionally accredited institution,

                 •   Three semester hours of approved Alaska Studies coursework,

                 •   Three semester hours of approved Alaska Multicultural coursework, and

                 •   Six semester hours of college coursework within the last five years (recency
                     credit). If the Alaska Studies course and Alaska Multicultural course were
                     completed within the last five years, they will satisfy the recency requirement.

           Two years of teaching experience while holding a valid teacher certificate

           Passing scores on an approved content area exam (e.g. Praxis II)

           A FD-258 fingerprint card with $66 processing fee or employment verification

           Application fee--$125.00

           A complete Professional teacher certificate application




                  Department of Education & Early Development, Teacher Education and Certification
                         801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                        Phone: (907) 465-2831 Fax: (907) 465-2441
Initial          www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov         11/17/11
TEACHER CERTIFICATION APPLICATION
                      RECOMMENDATIONS & PROGRAM ENROLLMENT
                                                                                                            Page 11 of 18


You must submit an Institutional Recommendation, a State Recommendation, or a Proof of Program
Enrollment form with your Initial application or have one on file with teacher certification. Use only the
form that applies to your situation.

If you completed a university teacher preparation program, submit the Institutional Recommendation with your
application.

If you completed a state-approved (non-university) program, submit the State Recommendation with your application.

If you have not completed a teacher preparation program but are enrolled in one, submit the Proof of Program
Enrollment form with your application.

If you have completed a teacher preparation program outside of the United States, you will need to submit a complete,
orginal foreign evaluation from an approved agency. More information concerning foreign evaluations can be found at
http://www.eed.state.ak.us/teachercertification/forms/Foreign_Evaluation_Info.pdf.

You may discard the forms that do not apply to your situation.
_______________________________________________________________________________________________
APPLICANT DIRECTIONS:

      1)   Complete the APPLICANT INFORMATION section on both pages of the appropriate form.

      2)   Leave the remaining sections of the form blank. The university or state agency must complete all other
           sections.

      3)   Contact the university or state agency to determine who within the organization has the authority to verify the
           completion of or enrollment in a state-approved teacher preparation program.

      4)
       If your teacher preparation program is at a university, mail or fax the form and the list of endorsements (p.12)
       to the Dean or Certification Officer within the university where you completed your program or where you are
       currently enrolled.
       -OR-
       If your teacher preparation program was completed in a state-approved (non-university) program, mail or fax
       the State Recommendation form and the list of endorsements (p.12) to the state official who has the authority
       to verify your completion of a state-approved alternate route to teacher certification.
_______________________________________________________________________________________________
UNIVERSITY OR STATE AGENCY DIRECTIONS:

      1)   Provide all of the requested information in the following sections of the Institutional Recommendation, State
           Recommendation or the Proof of Program Enrollment form provided by the applicant:

               a.   PROGRAM STANDARDS
               b.   DEGREE INFORMATION
               c.   ENDORSEMENT INFORMATION
                    (INCLUDED IN THE ADMISSION INFORMATION ON THE PROOF OF PROGRAM ENROLLMENT
                    FORM)
               d.   SIGNATURE
               e.   STAMP OR SEAL
               f.   ADMINISSION INFORMATION (PROOF OF PROGRAM ENROLLMENT ONLY)

      2)   If a Stamp or Seal is not available, complete all information using blue ink.

      3)   Please return the original Institutional Recommendation, State Recommendation or the Proof of Program
           Enrollment form to the applicant. Photocopies/faxes will not be accepted.


If you have any questions concerning the completion of the Institutional Recommendation, State Recommendation or
the Proof of Program Enrollment form, please email tcwebmail@alaska.gov for assistance.




                     Department of Education & Early Development, Teacher Education and Certification
                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov            11/17/11
TEACHER CERTIFICATION APPLICATION
                                             LIST OF ENDORSEMENTS
                                                                                                           Page 12 of 18

TEACHING ENDORSEMENTS
Art                                          Alaska Native Studies                  Business
Art                                          Alaska Native Studies                  Business Education
Music                                        Aleut Language/Culture                 Business Communication
Music – Choral                               Athabascan Language/Culture            Computer Education
Music – Instrumental                         Haida Language/Culture                 Marketing
Theater Arts                                 Inupiaq Language/Culture
Visual Arts                                  Tlingit Language/Culture
                                             Yupik Language/Culture

Early Childhood                              Educational Technology                 Elementary Education
Early Childhood Education                    Educational Technology                 Elementary Education
Special Ed – Early Childhood
Languages
Bilingual Education                          Language Arts                          Mathematics
English as a Foreign Language                English                                Mathematics
English as a Second Language                 Language Arts
Chinese                                      Literature                             Middle School
Japanese                                     English Literature                     Middle School
French                                       Russian Literature
German                                       Communication
Italian                                      Speech                                 Physical Education
Latin                                        Journalism                             Physical Education
Russian                                      Humanities                             Coaching
Spanish                                                                             Kinesiology
                                                                                    Adaptive P.E.
Reading
Reading                                      Science
Reading Specialist                           Science                                Social Studies
Remedial Reading                             Biology                                Social Studies
                                             Chemistry                              Anthropology
Special Education                            Earth Science                          Economics
Special Education                            Environmental Science                  Government
Physically Handicapped                       General Science                        History
Visually Handicapped                         Geology                                Political Science
Hearing Impaired                             Health                                 Social Science
Learning Disability                          Life Science                           Sociology
Emotionally Disturbed                        Natural Science                        U.S. History
Cognitively Impaired                         Physical Science                       World History
Communication Disorders                      Physics                                Russian History
Multi-Handicapped                            Zoology                                Geography
Resource                                                                            Psychology
Adaptive P.E.                                Library
Special Ed – Early Childhood                 (Only available if applicant has       Vocational Education
                                             completed a teacher preparation        Vocational Education
                                             program.)                              Technology Education
                                             School Librarian                       Family/Consumer Science
                                             Library Science                        Industrial Arts
                                             Media Specialist                       Industrial Technology



GRADE LEVELS
Birth – Grade 3              Grades   K-3        Grades 5-8       Grades 7-10    Grades 9-12
Pre K – Grade 3              Grades   K-5        Grades 5-12      Grades 7-12
Pre K – Grade 12             Grades   K-8
                             Grades   K-12




                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov           11/17/11
TEACHER CERTIFICATION APPLICATION
                                    INSTITUTIONAL RECOMMENDATION
                                                                                                                        Page 13 of 18

This form should only be used if a standard, university teacher preparation program has been completed.


APPLICANT INFORMATION
This section is to be completed by the applicant before submission to the college/university. All other sections are to be completed by
the preparing institution’s school of education.



LAST NAME                           FIRST NAME                           MIDDLE INITIAL SOCIAL SECURITY NUMBER



MAILING ADDRESS                                                       CITY                        STATE         ZIP CODE

The remaining sections are to be completed by the preparing institution’s school of education, not the applicant.


COLLEGE/UNIVERSITY INFORMATION
Alaska certifies teachers who have completed approved university teacher preparation programs or state-approved teacher preparation
programs. Please sign this form only if the candidate has completed a university teacher preparation program, which meets your
state’s standards for teacher certification. All endorsements listed on this form must be based only on the completion of approved
university programs.

Your state’s requirements for certification and endorsements may vary from your approved program. Do not sign this form if the
applicant has only met your state’s requirements for certification or endorsement, but has not completed the approved
program. Deviations from your institution’s approved program may be acceptable, but require a formal rationale on university
letterhead along with supporting documentation.


PROGRAM STANDARDS                                                      DEGREE INFORMATION
Specify which standards the approved program meets:                    Please specify the type of approved program completed:

 NCATE                                                                 B.ED        MA          ED.D
 STATE STANDARDS FROM AN NCATE PARTNERSHIP STATE                       BS          MS          PH.D
 STATE STANDARDS FROM AN NON-NCATE PARTNERSHIP STATE                   BA          MAT         NO DEGREE/CERTIFICATION ONLY
 NASDTEC                                                                            M.ED        OTHER ________________
 OTHER ________________

ENDORSEMENT INFORMATION
Please refer to the “List of Endorsements” before entering any information. All endorsements listed below must be included on the
attached list of endorsements. If the list of endorsements is not provided to you by the applicant, please contact Teacher Certification
for available endorsements.


                                  GRADE              YEAR OF                                               GRADE             YEAR OF
          CONTENT AREA                                                        CONTENT AREA
                                 LEVEL(S)          COMPLETION                                             LEVEL(S)         COMPLETION


1. __________________           ___________        ____________         4. ____________________          ___________       ____________


2. ____________________         ___________        ____________         5. ____________________          ___________       ____________


3. ____________________         ___________        ____________         6. ____________________          ___________       ____________


By signing below, I verify that the applicant has met all institutional requirements for the approved programs (as defined above) in the
areas listed below.   In addition, I verify that the applicant maintained ethical standards required of an educator while attending the
institution.



SIGNATURE OF DEAN OR CERTIFYING OFFICIAL            PRINTED NAME                         TITLE                           DATE

                                                     -CONTINUED ON NEXT PAGE-



                     Department of Education & Early Development, Teacher Education and Certification
                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                        11/17/11
TEACHER CERTIFICATION APPLICATION
                                 INSTITUTIONAL RECOMMENDATION
                                                                                                          Page 14 of 18


This form should only be used if a standard, university teacher preparation program has been completed.


APPLICANT INFORMATION


LAST NAME                   FIRST NAME                  MIDDLE INITIAL          SOCIAL SECURITY NUMBER


SIGNATURE


NAME OF INSTITUTION                                         CITY                         STATE



REGIONAL ACCREDITING ASSOCIATION



SIGNATURE OF DEAN OR CERTIFYING OFFICIAL        PRINTED NAME                   TITLE                       DATE



                -                -                                       -                -
PHONE NUMBER                                              FAX NUMBER




EMAIL ADDRESS



STAMP OR SEAL




COLLEGE STAMP OR SEAL – IF NOT
AVAILABLE, FORM MUST BE SIGNED IN BLUE INK




            Please return the Institutional Recommendation to the applicant.
                        Photocopies/faxes will not be accepted.




                     Department of Education & Early Development, Teacher Education and Certification
                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov           11/17/11
TEACHER CERTIFICATION APPLICATION
                                       PROOF OF PROGRAM ENROLLMENT
                                                                                                                          Page 15 of 18

This form cannot be used for individuals enrolled in special education programs. Those individuals must
complete their program prior to applying for initial certification.


APPLICANT INFORMATION
This section is to be completed by the applicant before submission to the regionally accredited college/university. All other sections are
to be completed by the preparing institution’s school of education.




LAST NAME                            FIRST NAME                             MIDDLE INITIAL SOCIAL SECURITY NUMBER



MAILING ADDRESS                                                          CITY                          STATE        ZIP CODE


The remaining sections are to be completed by the preparing institution’s school of education, not the applicant.




ADMISSION INFORMATION
 1. Has the applicant been admitted to an approved teacher education program, leading to certification?
     YES NO
 2. What is the applicant’s anticipated program completion date? _______________________ (MM/DD/YYYY)


 3. How many credits of the approved program has the applicant completed?
                                                                                     ____________ CREDITS

 4. How many total credits are in the approved program?
                                                               ____________ CREDITS

 5. The applicant is currently enrolled in a program leading to certification in the area(s) listed below:


               CONTENT AREA                        GRADE LEVEL(S)                       CONTENT AREA                    GRADE LEVEL(S)


     1. ______________________________              ____________            3. ______________________________             ____________


     2. ______________________________              ____________            4. ______________________________             ____________

 NOTE: This form cannot be used for individuals enrolled in special education programs. Those individuals must complete their program
 prior to applying for the Initial certificate.


PROGRAM STANDARDS
Specify which standards the approved program meets:
                                                                         NCATE
                                                                         NASDTEC
                                                                         STATE STANDARDS FROM AN NCATE PARTNERSHIP STATE
                                                                         STATE STANDARDS FROM AN NON-NCATE PARTNERSHIP STATE
                                                                        OTHER: _____________________
DEGREE INFORMATION
                                                                BA          MAT M.ED NO DEGREE/CERTIFICATION ONLY
Please specify the type of program enrollment:
                                                                BS          MA ED.D OTHER: _____________________
                                                                B.ED        MS PH.D


                                                       -CONTINUED ON NEXT PAGE-


                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                         11/17/11
TEACHER CERTIFICATION APPLICATION
                                  PROOF OF PROGRAM ENROLLMENT
                                                                                                         Page 16 of 18

This form cannot be used for individuals enrolled in special education programs. Those individuals must
complete their program prior to applying for initial certification.


APPLICANT INFORMATION


LAST NAME                   FIRST NAME                  MIDDLE INITIAL          SOCIAL SECURITY NUMBER



SIGNATURE


NAME OF INSTITUTION                                         CITY                         STATE



REGIONAL ACCREDITING ASSOCIATION



SIGNATURE OF DEAN OR CERTIFYING OFFICIAL        PRINTED NAME                   TITLE                      DATE



                -                -                                       -                -
PHONE NUMBER                                              FAX NUMBER




EMAIL ADDRESS



STAMP OR SEAL




COLLEGE STAMP OR SEAL – IF NOT
AVAILABLE, FORM MUST BE SIGNED IN BLUE INK




            Please return the Proof of Program Enrollment to the applicant.
                        Photocopies/faxes will not be accepted.




                     Department of Education & Early Development, Teacher Education and Certification
                            801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                           Phone: (907) 465-2831 Fax: (907) 465-2441
Initial             www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov          11/17/11
TEACHER CERTIFICATION APPLICATION
                                               STATE RECOMMENDATION
                                                                                                                              Page 17 of 18

Do not use this form if you have completed a teacher preparation program through a university or college. This form
should be completed only if the individual has completed an approved alternate program to certification.


APPLICANT INFORMATION
This section is to be completed by the applicant before submission to the state department of education. All other sections are to be
completed by the preparing state’s commissioner of education.




LAST NAME                             FIRST NAME                            MIDDLE INITIAL SOCIAL SECURITY NUMBER



MAILING ADDRESS                                                          CITY                          STATE         ZIP CODE

The remaining sections are to be completed by the preparing state’s chief state school officer or certifying official, not the applicant.


STATE INFORMATION
Alaska certifies teachers who have completed approved university teacher preparation programs or state-approved
teacher preparation programs. Please sign this form only if the candidate has completed a state-approved teacher
preparation program which meets your state’s standards for teacher certification. Please do not sign this form if the
alternate program was based solely on transcript analysis and testing.
All endorsements listed on this form must be based only on the completion of state-approved programs. Do not
include endorsements based only on testing alone. If the candidate has completed an approved university teacher
preparation program, the preparing university must complete an institutional recommendation, not this state
recommendation.


PROGRAM STANDARDS                                                       DEGREE INFORMATION
Specify which standards the state-approved program meets:               Please specify the type of state-approved program completed:

 NCATE                                                                  B.ED            MA              ED.D
 NASDTEC                                                                BS              MS              PH.D
 STATE                                                                  BA              MAT             NO DEGREE/CERTIFICATION ONLY
 OTHER: _______________________________                                                  M.ED            OTHER ________________
PLEASE SELECT ONE OF THE FOLLOWING:
 COMPLETED STUDENT TEACHING
 COMPLETED MENTORED/SUPERVISED TEACHING
 REQUIREMENT WAIVED FOR SATISFACTORY EXPERIENCE

ENDORSEMENT INFORMATION
This state verifies that the applicant has met all state requirements for the approved state approved program(s) in the areas listed
below. Do not include endorsements based only on testing.
                                    GRADE               YEAR OF                                                 GRADE              YEAR OF
          CONTENT AREA                                                           CONTENT AREA
                                   LEVEL(S)           COMPLETION                                               LEVEL(S)          COMPLETION


1. ____________________          ___________          ____________          4. ____________________           ___________        ____________


2. ____________________          ___________          ____________          5. ____________________           ___________        ____________


3. ____________________          ___________          ____________          6. ____________________           ___________        ____________

By signing below, I verify that the applicant has met all l requirements for the state approved programs (as defined above) in the areas
listed. In addition, I verify that the applicant maintained ethical standards required of an educator while attending the institution.


CERTIFYING OFFICIAL                                     PRINTED NAME                         TITLE                             DATE

                                                    -CONTINUED ON NEXT PAGE-
                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov                             11/17/11
TEACHER CERTIFICATION APPLICATION
                                           STATE RECOMMENDATION
                                                                                                          Page 18 of 18

Do not use this form if you have completed a teacher preparation program through a university or college.
This form should be completed only if the individual has completed an approved alternate program to
certification.


APPLICANT INFORMATION


LAST NAME                    FIRST NAME                  MIDDLE INITIAL          SOCIAL SECURITY NUMBER



SIGNATURE


STATE



SIGNATURE OF STATE OFFICIAL                   PRINTED NAME                     TITLE                       DATE


                -                 -                                       -                -

PHONE NUMBER                                                 FAX NUMBER




EMAIL ADDRESS



STAMP OR SEAL




STATE STAMP OR SEAL (IF AVAILABLE). IF NOT
AVAILABLE, FORM MUST BE SIGNED IN BLUE INK




                    Please return the State Recommendation to the applicant.
                             Photocopies/faxes will not be accepted.




                      Department of Education & Early Development, Teacher Education and Certification
                             801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500
                                            Phone: (907) 465-2831 Fax: (907) 465-2441
Initial              www.eed.state.ak.us/teachercertification               tcwebmail@alaska.gov          11/17/11

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Initial

  • 1. APPLICATION INSTRUCTIONS INITIAL CERTIFICATION Page 1 of 18 PERSONAL INFORMATION Enter all personal information in the spaces provided, including contact phone number(s) and email address. The address entered will be the address that your certificate will be mailed. It is the responsibility of the applicant to maintain current information, including name and mailing address, on file with the Teacher Certification office. BACKGROUND INFORMATION Answer “yes” or “no” to questions one through six (1-6) as they apply to you. If the answer to any of these questions is “yes,” please provide a written, detailed explanation of the incident and sign it. It is not necessary to provide a written explanation of a minor traffic violation. Include a written explanation of incidences involving Driving While Intoxicated (DWI) or Driving Under the Influence (DUI). If no written explanation is provided for any “yes” answers to questions one through six (1-6), the application will be returned. If you answer “yes” to question seven (7), list the state(s) where you hold/held teaching certificates and the expiration date(s). ETHNICITY Check the box that most appropriately applies to you. Definitions for each choice are provided. CERTIFICATION SELECTION & REQUIREMENTS Use the lists of requirements under each Initial certificate type to determine if you qualify for an Initial certificate. Check the box next to the type of Initial certificate for which you are applying. RECORD OF TRAINING List all colleges/universities you attended to complete your degree(s) and approved teacher preparation program(s). You must include all college coursework, including community college or transfer credits. Your official transcripts must show the completion of at least a bachelor’s degree from a regionally accredited university to qualify for Alaska teacher certification. If you completed your degree outside of the United States, a complete, original foreign evaluation must be submitted with your application. If you have completed the required Alaska Multicultural or the required Alaska Studies coursework, please provided the requested information. If you have not completed the required coursework, indicate the courses you plan to take and the anticipated dates of completion. Official transcripts for all institutions listed in this section must be included with the application or on file with the Teacher Certification office. Do not request universities to submit transcripts directly to the Teacher Certification office. We encourage you to open the sealed transcripts when they arrive to verify the correct coursework and/or degree(s) are posted. We accept official transcripts after they have been opened, provided the transcripts bear the registrar’s signature/seal and are printed on official university transcript paper. Unofficial transcripts, electronic transcripts, or photocopies will not be accepted. BASIC COMPETENCY EXAM Indicate the approved Basic Competency Exam (BCE) that you have passed or indicate the date that you are scheduled to take an approved BCE. If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Educational Testing Services (ETS), or you can include an original/official examinee score report with your application. To contact ETS, visit www.ets.org. If you have the scores sent directly from ETS, email the Teacher Certification office at tcwebmail@alaska.gov to verify that passing Praxis I scores are on file BEFORE sending the application. The application will be returned if it is submitted before passing Praxis I scores have been received in the Teacher Certification office. For all other approved basic competency exams, an original/official examinee score report showing passing scores on all three sections of the exam must be included with the application. More information concerning approved exams is available on our website at http://www.eed.state.ak.us/teachercertification/praxis.html. PREVIOUS ALASKA CERTIFICATION & AUTHORIZATIONS Indicate the statements that describe your previous Alaska certification status. If applicable, provide the requested information concerning your previous Alaska certifications or authorizations. REQUESTED ENDORSEMENTS Endorsements will only be granted if they have been requested in this section of the application. List all teaching endorsements that you are requesting to be on your Initial teacher certificate. When requesting endorsements, please indicate content area and grade levels if applicable. Requesting an endorsement does not guarantee that the endorsement area will be granted. Endorsements will only be granted based on Alaska’s endorsement requirements. If you are applying using a current, valid out-of-state certificate, the endorsements on your Initial Alaska teacher certificate will reflect those endorsements listed on your current, valid out-of-state certificates that correspond to the endorsements on the List of Endorsements on page 12. If the applicant holds more than one current, valid out-of-state certificate, the applicant must choose which out-of-state certificate to submit with the Initial application. If the requested endorsement section is left blank, the application will be returned. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 2. APPLICATION INSTRUCTIONS INITIAL CERTIFICATION Page 2 of 18 FINGERPRINT CARD CHECKLISTS One (1) complete fingerprint card is a requirement for all applicants for Initial certification, with a few exceptions. If you need a fingerprint card, email the Teacher Certification office at tcwebmail@alaska.gov and request that a card be sent to you. You must have your fingerprints rolled by a trained technician. The technician must sign and date the card in the appropriate space. All personal information must be filled in, including signature, residence, citizenship, sex, height, weight, race, eye color, hair color, date of birth, and place of birth. If you held an Alaska Student Teacher Authorization which expired less than 60 days prior to the date your Initial teacher certification application is received by the Teacher Certification office and your background clearance was completed less than 18 months from the date of application, you do not need to submit a fingerprint card with your Initial application. Email the Teacher Certification office at tcwebmail@alaska.govv to determine if your previous background clearance can be used for this application. If you have submitted a fingerprint card for a background check to the Teacher Certification office in the previous six months, email the Teacher Certification office at tcwebmail@alaska.gov to determine if your previous background check can be used for this application. FEE SCHEDULE The application fee for the Initial certificate is $125.00. The fingerprint processing fee is an additional $66.00. All applicants for the Initial certificate must include payment in the form of a cashier’s check, money order, credit card or debit card. Fees are non- refundable. No personal checks will be accepted. If paying by credit or debit card, complete all information in this section, including the name on the card and the cardholder’s signature. Cashier’s checks or money orders can be made payable to the Alaska Department of Education & Early Development (EED). REQUIREMENT CHECKLISTS Review your application before submitting it to the Teacher Certification office. You must include all the items on the checklists that apply to the type of Initial teacher certificate for which you are applying. If any of the required documents listed on the applicable checklists are not included with the application, the entire application will be returned. You must have completed all requirements listed in this section in order to qualify for Initial certification. If you have not met all of the requirements listed in this section, the application will be returned. If you have questions about the requirements, please email the Teacher Certification office at tcwebmail@alaska.gov. IMPORTANT NOTES Read the important notes that are associated with the type of Initial teacher certificate for which you are applying. When you sign the notarization section, you will attest that you understand the requirements that still need to be met to maintain your Initial teacher certificate and to qualify for a Professional teacher certificate. See page 10 of the application for a list of requirements for Professional teacher certification. NOTARIZATION The application must be signed and dated by the applicant in the presence of a Notary Public or Postmaster. The application must be notarized by a certified Notary Public. If a Notary Public is not available to you, a Postmaster may sign, date, and stamp this affidavit. If any portion of this section is incomplete, the application will be returned. RECOMMENDATIONS & PROOF OF PROGRAM ENROLLMENT You must submit an Institutional Recommendation, a State Recommendation, or a Proof of Program Enrollment form with this application or have one on file with the Teacher Certification office. These forms are located on pages 13-18. Use only the form that applies to your situation. The appropriate form must first be sent to the university or state agency where you completed or are enrolled in an approved teacher preparation program. More detailed directions on the completion of these forms can be found on page 11. NOTE: Proof of Program Enrollment cannot be used for individuals enrolled in special education programs. Those individuals must complete their program prior to applying for the Initial certificate. Applicants that are applying for an Initial/Out-of-State certificate have one year for the issue date of their certificate to submit an Institutional Recommendation, a State Recommendation, or a Proof of Program Enrollment form to our office. MAIL YOUR APPLICATION The application and supporting documents must be mailed to the Teacher Certification office at the following address: Department of Education & Early Development Teacher Education & Certification 801 West 10th Street, Suite 200 PO Box 110500 Juneau, AK 99811-0500 If you would like your original documents (i.e. Out-of-State certificate, original score report) to be returned, you must include a self- addressed, stamped envelope with your application packet. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 3. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 3 of 18 PERSONAL INFORMATION LAST NAME FIRST NAME M.I. SOCIAL SECURITY NUMBER MAILING ADDRESS CITY STATE ZIP CODE HOME PHONE NUMBER WORK OR MOBILE PHONE NUMBER GENDER HOME EMAIL ADDRESS - - BIRTHDATE (MM-DD-YYYY) FORMER LAST NAME(S) HIGHEST EDUCATIONAL DEGREE It is the responsibility of the applicant to maintain current information, including name and mailing address, on file with the Teacher Certification office. All name changes must be supported with a photocopy of the legal document verifying the change. BACKGROUND INFORMATION Answer the following questions carefully and completely. If you answer “yes” to any of the questions 1-6, provide a detailed statement in the box below or on a separate sheet of paper. Any falsification or deliberate misrepresentation, including omission of a material fact, in completion of this application can be grounds for denial of certification. YES NO 1. Have you been convicted for a violation of criminal law, except for minor traffic violations? Please include convictions for Driving While Intoxicated (DWI) and Driving Under the Influence (DUI). YES NO 2. Do you currently have any outstanding criminal charges or warrants of arrest pending against you? This would include any state, province, territory, and/or country. YES NO 3. Is there action pending to revoke or suspend a certificate or license issued to you by another jurisdiction? If “yes,” on a separate sheet of paper, list the agency, including complete address and telephone number as well as the purpose of the investigation or inquiry. YES NO 4. Have you ever had any adverse action taken on any certificate or license? (Adverse action includes letters of warning, reprimands, suspensions, revocations, voluntarily surrenders, or voidance) YES NO 5. Are you currently or have you ever been the subject of any certificate or licensing investigation or inquiry by any certification or licensing agency for allegations of misconduct? If “yes,” on a separate sheet of paper, list the agency, including complete address and telephone number as well as the purpose of the investigation or inquiry. YES NO 6. Have you ever been denied certification? This would include any state, province, territory, and/or country. If you answered “yes” to any of the questions above (1-6), provide a detailed statement here. If you need additional spaces, provide the detailed statement on a separate sheet of paper and sign it. YES NO 7. Have you ever held a teaching certificate in another state? If yes, please complete the following. STATE EXPIRES: STATE EXPIRES YES NO 8. Are you currently under contract or have been offered a contract with a public school district in Alaska? If yes, please complete the following. Alaska public school district: _________________________________, beginning contract date: _______________ Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 4. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 4 of 18 ETHNICITY Alaska Native: Any person having origins in any of the original peoples of Alaska, and who maintains Alaska Native cultural identification through tribal affiliation or community recognition. This may include, for Asian or Pacific example, any person of Yup’ik, Inupiat, Aleut, Athabascan, Tlingit, Haida, or Tsimshian origin. Islander Asian or Pacific Islander: Any person having origins in any of the original peoples of the Far East, Southeast African American Asia, the Indian Subcontinent, or the Pacific Islands. This includes, for example, China, Japan, Hispanic Korea, the Philippine Islands and Samoa. Caucasian African American: (Not of Hispanic origin); any person having origins in any of the Black racial groups of American Indian/ Africa. Native American Hispanic: Any person of Mexican, Puerto Rican, Cuban, Central American, or other Spanish culture or origin, Other regardless of race Caucasian: (Not of Hispanic origin); any person having origins in any of the original peoples of Europe, North Africa, or the Middle East. American Indian/Native American: Any person having origins in any of the original peoples of North America (not including Alaska), and who maintains cultural identification through tribal affiliation or community recognition. CERTIFICATE SELECTION & REQUIREMENTS Use the lists of requirements under each certificate type to determine if you qualify for an Initial certificate. Check the box next the type of Initial certificate for which you are applying.  INITIAL/2-YEAR  INITIAL/3-YEAR  Passing scores on an approved Basic  Passing scores on an approved Basic Competency Exam Competency Exam  Completed state-approved teacher preparation  Completed state-approved teacher preparation program program  Never held an Initial or Provisional Alaska  Never held an Initial or Provisional Alaska teacher certificate teacher certificate -and- -and- Not eligible for reinstatement of a Professional  Not eligible for the reinstatement of a or Master teacher certificate. Professional or Master teacher certificate.  Official transcripts showing:  INITIAL/OUT-OF-STATE (1-YEAR) o 3 semester hours of approved Alaska Studies coursework  Has never held Alaska teacher certification o 3 semester hours of approved Alaska  Holds current, valid out-of-state certificate at Multicultural coursework the time of Initial application  The out-of-state certificate will be current and  INITIAL/PROGRAM ENROLLMENT valid at the time the applicant’s contract for (1-Year) instructional services begins in an Alaska public school district  Has never held Alaska teacher certification  INITIAL/REEMPLOYMENT (1-YEAR)  Passing scores on an approved Basic Competency Exam  Has never held an Alaska Reemployment  Currently enrolled in a state-approved teacher teacher certificate preparation program  Held an Alaska teacher certificate that was  NOTE: Individuals enrolled in a Special valid for at least two years Education teacher preparation program is not  The most recent Alaska teacher certificate eligible for an Initial teacher certificate using must have expired more than a year prior to Program Enrollment the date of application. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 5. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 5 of 18 RECORD OF TRAINING Official transcripts of all academic work completed must be included with the application or be on file with our office. Your official transcripts must show the completion of at least a bachelor’s degree from a regionally accredited university to qualify for Alaska teacher certification. If you completed your degree outside of the United States, a complete, original foreign evaluation must be submitted with your application. Official transcripts may be opened, but not marked on in any way. Unofficial, photocopied, electronic or faxed transcripts or evaluations will not be accepted. DEGREE(S) YEARS COLLEGE OR UNIVERSITY CITY, STATE MAJOR/PROGRAM EARNED ATTENDED Indicate the college or university where you have met or plan to meet following coursework requirements. REQUIREMENTS COLLEGE OR UNIVERSITY COURSE DATE OR ANTICIPATED NUMBER(S) DATE OF COMPLETION Three (3) semester hours of APPROVED Alaska Studies coursework Three (3) semester hours of APPROVED Multicultural/Cross-cultural Communications coursework BASIC COMPETENCY EXAM Indicate the approved basic competency exam (BCE) that you have passed or indicate the date that you are scheduled to take one of the approved BCE.  California Basic  Florida Teacher  Michigan Test for  Oklahoma General Educational Skills Certification Exam Teacher Certification Education Test Test (C-BEST) (MTTC) (OGET)  Washington Educator  Georgia Assessment  New Mexico  New York State Skills Test-Basic for the Certification of Assessment of Teacher Certification (WEST-B) Teachers Teacher Basic Skills Liberal Arts and Sciences Test  Praxis I (Math,  Alabama Work Keys  Illinois Certification Reading & Writing) Testing System  I am scheduled to take an approved basic competency exam on _________________________. If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Educational Testing Services (ETS), or you can include an original/official examinee score report with your application. To contact ETS, visit www.ets.org. If you have had the scores sent directly from ETS, email the Teacher Certification office at tcwebmail@alaska.gov to verify passing Praxis I scores are on file, BEFORE sending in the application. For all other approved basic competency exams, an original examinee score report showing passing scores on all three sections of the exam must be included with the application. PREVIOUS ALASKA CERTIFICATION & AUTHORIZATIONS Indicate which statements describe your Alaska certification status. If you have held an Alaska teacher certificate prior to this application, you will need to verify whether or not you are eligible to apply for an Initial teacher certificate. Please refer to the Certification Selection & Requirements section of this application for more information.  I held an Alaska Student Teacher Authorization that expired on ___________________________.  I have never held an Alaska teacher certificate.  I have held the following Alaska teacher certificates with the expiration dates indicated below: Certificate Type Expiration Date(s) Certificate Type Expiration Date (s) Initial/Sec nd Provisional/Temporary Initial Professional/Type A Reemployment Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 6. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 6 of 18 REQUESTED ENDORSEMENTS List all requested endorsements, content or specialty area(s), and grade levels. Qualifying endorsements will only be granted if they have been requested in this section of the application. You may only request endorsement areas found on the “List of Endorsements” located on page 12 of this application. INITIAL/2-YEAR OR 3-YEAR: Endorsements may be requested based on your Institutional Recommendation; State Recommendation; and posted degree, major, or minor (of at least 18 semester hours). In the areas of English, Mathematics, General Science, French, and German, you may also request endorsements based on passing scores on the required Praxis II exams. INITIAL/OUT-OF-STATE: Endorsements will only reflect those endorsements listed on the applicant’s current, valid out-of-state certificates that correspond to the endorsements on the List of Endorsements. If the applicant holds more than one current, valid out-of-state certificate, the applicant must choose which out-of-state certificate to submit with the Initial application. INITIAL/PROGRAM ENROLLMENT: Endorsements will reflect the teacher preparation program described on the Proof of Program Enrollment form. INITIAL/REEMPLOYMENT: Endorsements will reflect the endorsements on the applicant’s previous Alaska teacher certificate. CONTENT AREA GRADE LEVEL(S) CONTENT AREA GRADE LEVEL(S) (SAMPLE) ELEMENTARY EDUCATION ____K-8_____ 3. ___________________________ ___________ 1. ___________________________ ____________ 4. ___________________________ ___________ 2. ___________________________ ____________ 5. ___________________________ ___________ FINGERPRINT CARD CHECKLIST If you are required to submit one (1) fingerprint card, Form FD-258 or similar, with your application, please use the following checklist to make sure that all the required information on the fingerprint card has been completed. If any section of the fingerprint card is incomplete, the entire application packet will be returned. If you cannot obtain a fingerprint card locally, email the Teacher Certification office at tcwebmail@alaska.gov to request a card be sent to you. More information can be found at http://www.eed.state.ak.us/TeacherCertification/fingerprints.html.  Fingerprints must be rolled by a trained technician.  The technician must sign and date the card in the appropriate space  All personal information below must be filled in:  signature  height hair color  residence  weight date of birth  citizenship  race place of birth  gender  eye color Previous Clearance (For Initial Applicants who hold or have held a Student Teacher Authorization) If you held an Alaska Student Teacher Authorization that expires less than 60 days prior to the date your application is received by the Teacher Certification office, and your background clearance was completed less than 18 months from the date of application, you do not need to submit a fingerprint card with your Initial application. Email the Teacher Certification office at tcwebmail@alaska.gov to determine if your previous background clearance can be used for your Initial teacher application. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 7. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 7 of 18 FEE SCHEDULE The application fee is $125.00. The fingerprint processing fee is $66.00. If you require a fingerprint card, submit a total of $191.00. You may pay with a cashier’s check (payable to EED), money order, credit card or debit card (Visa, Discovery or MasterCard). Fees are non-refundable. Personal checks will not be accepted. 0 0 . AMOUNT - - - / CREDIT CARD NUMBER EXPIRATION DATE (MM/YY) NAME ON CREDIT CARD CARDHOLDER’S SIGNATURE REQUIREMENT CHECKLISTS You must include all of the items required for the certificate for which you are applying in a single application packet. If any item is missing, the entire application packet will be returned unprocessed. Mark the checkbox next to each requirement to indicate the item is included in your application packet or on file with the Teacher Certification office. Photocopied/faxed applications will not be accepted. ALL INITIAL APPLICANTS  Complete Initial Application (pages 3 -10) Make sure all sections of the application are complete. If any section is incomplete, all documents will be returned. The application must be mailed to the Teacher Certification office at the address below.  Official transcripts verifying a Bachelor’s Degree or Higher, from a regionally accredited institution (page 5) Official transcripts reflecting all coursework and degree(s) must be included with the application or on file with the Teacher Certification Office, including community college and/or transfer credit. Unofficial, photocopied, faxed, or electronic transcripts will not be accepted. If you completed your degree outside of the United States, a complete, original foreign evaluation must be submitted with your application. Official transcripts or original foreign evaluation may be opened, but not marked on in any way. ALL INITIAL APPLICANTS  Fingerprint Card (page 6) You are required to submit one (1) FBI Applicant fingerprint card (Form FD-258). If you cannot obtain the fingerprint card locally, email the Teacher Certification office to request a card be sent to you. Use the Fingerprint Card Checklist to make sure that all required items have been completed. If any section of the fingerprint card is incomplete, the entire application packet will be returned. -OR- Previous Clearance (For Initial Applicants who held or hold a Student Teacher Authorization) If you held an Alaska Student Teacher Authorization which expired less than 60 days prior to the date your application is received by the Teacher Certification office and your background clearance was completed less than 18 months from the date of application, you do not need to submit a fingerprint card with your Initial application. Email the Teacher Certification office at tcwebmail@alaska.gov to determine if your previous background clearance can be used for your Initial teacher application.  Application Fees (page 7) The application fee for an Initial certificate is $125.00. The fingerprint processing fee is $66.00. Submit a total fee of $191.00. Fees are non-refundable. You may pay with a cashier’s check, money order, or credit or debit card. No personal checks will be accepted.  Signature and Notarization (page 9) The “Notarization” section of the application must be completed. A Notary Public or a Postmaster must witness and verify your signature with a signature and stamp/seal. REQUIREMENT CHECKLISTS CONTINUES ON THE NEXT PAGE Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 8. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 8 of 18 REQUIREMENT CHECKLISTS (continued) INITIAL/2-YEAR & 3-YEAR  Passing Scores on an approved Basic Competency Exam (BCE) (page 5) If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Educational Testing Service (ETS), or you can include an original examinee score report with your application. To contact ETS, visit www.ets.org. Email the Teacher Certification office to verify passing Initial/2-year & 3-year Praxis I scores are on file, BEFORE sending in the application. For all other approved basic competency exams, an original examinee score report must be included with the application. Photocopies of reports will not be accepted. -AND-  Institutional Recommendation verifying the completion of an approved Teacher Education Program Offered by a regionally accredited institution (pages 13-14) The preparing institution must complete the Institutional Recommendation (IR) form. The original form must be included with the application. Photocopies/faxes will not be accepted. –OR- State Recommendation verifying the completion of a state Approved Teacher Preparation Program (pages 17-18) The preparing State must complete the State Recommendation form. The original form must be included with the application. Photocopies/faxes will not be accepted. –OR- Foreign Evaluation verifying the completion of a teacher preparation outside of the United States (See http://www.eed.state.ak.us/teachercertification/forms/Foreign_Evaluation_Info.pdf) INITIAL/3-YEAR Initial/3-yr.  Official transcripts verifying the completion of 3 semester hours of approved Alaska Studies and 3 semester hours of approved Alaska Multicultural coursework (page 5) Official transcripts reflecting all the required coursework must be included with the application or on file with the Teacher Certification Office. Unofficial, photocopied, faxed, or electronic transcripts will not be accepted. Official transcripts may be opened, but not marked on in any way. INITIAL/OUT-OF-STATE (OOS) Initial/OOS  Current, valid teaching certificate issued by another state (page 3) One official, original certificate or a duplicate certificate issued directly from that state’s Department of Education must be included. Photocopies will not be accepted. If the state’s Department of Education that issued your current, valid Out-of-State certificate only provides electronic copies of certificates, send a printout of the certificate from the website and provide the web address where our office can verify the status of your Out-of-State certificate. INITIAL/PROGRAM ENROLLMENT  Passing scores on an approved Basic Competency Exam (BCE) (page 5) If you have passing Praxis I scores, they can be sent to the Teacher Certification office directly from Initial/Enrollment Educational Testing Service (ETS), or you can include an original examinee score report with your application. To contact ETS, visit www.ets.org. Email the Teacher Certification office to verify passing Praxis I scores are on file, BEFORE sending in the application. For all other approved basic competency exams, an original examinee score report must be included with the application. Photocopies of reports will not be accepted.  Proof of Program Enrollment in an approved Teacher Education Program (page 15-16) The regionally accredited university offering the approved teacher education program must complete the Proof of Program Enrollment form. The original Proof of Program Enrollment form must be included with this application. NOTE: This form cannot be used for individuals enrolled in special education programs. Those individuals must complete their program prior to applying for the Initial certificate. Photocopies/faxes will not be accepted. INITIAL/REEMPLOYMENT (REEMPLOY) Initial/REEMPLOY  Previous Alaska Certificate that has been expired for longer than one year (page 5) A copy of the expired certificate must be included with the application or on file with the Teacher Certification office. NOTE: If you choose this option, within one year from the date the application is received by the Teacher Certification office, you must meet all requirements and apply for the Professional certification. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 9. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 9 of 18 IMPORTANT NOTES INITIAL/2-YEAR (INITIAL/2-YR) Within two years from the date that your application was received by the Teacher Certification office, official transcripts showing the completion of 3 semester hours of approved Alaska Studies coursework and 3 semester hours of approved Alaska Multicultural coursework must be received by the Teacher Certification office. Upon receipt of official transcripts showing completion of this required coursework, your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and Alaska Multicultural requirement, your certificate will expire and you will not be eligible to teach in an Alaska public school nor apply for an additional Alaska teacher certificate. INITIAL/OUT-OF-STATE (1-year certificate) Within one year from the date that your application was received by the Teacher Certification office, official passing scores on an approved Basic Competency Exam and a State or Institutional Recommendation must be received by the Teacher Certification office from the date your application was received. Upon receipt of an official scores report and your recommendation, your Initial certificate will be extended for one additional year. If the Teacher Certification office does not receive passing scores and the recommendation within the first year, your certificate will expire and you will not be eligible to teach in an Alaska public school. Within two years from the date that your application was received by the Teacher Certification office, official transcripts showing the completion of 3 semester hours of approved Alaska Studies coursework and 3 semester hours of approved Alaska Multicultural coursework must be received by the Teacher Certification office. Upon receipt of official transcripts showing the completion of the required coursework, your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and Alaska Multicultural requirement, your certificate will expire and you will not be eligible to teach in an Alaska public school nor apply for an additional Alaska teacher certificate. The endorsements on your Initial certificate will be the same as those on the current, valid, out-of-state certificate submitted with your application packet. If you hold more than one out-of-state certificate, you must choose ONE to submit with your application. When you apply for Professional Alaska certification, your transcripts, and Institutional Recommendation or State Recommendation will be analyzed to determine which endorsements will be awarded. INITIAL/PROGRAM ENROLLMENT (1-year certificate) Within one year from the date that your application was received by the Teacher Certification office, updated official transcripts and an updated Proof of Program Enrollment form showing progress toward completion of your teacher preparation program or official, updated official transcripts and an Institutional Recommendation showing the completion of a teacher preparation program must be received by the Teacher Certification office. Upon receipt of the transcripts and recommendation or program enrollment form, your Initial certificate will be extended for one additional year. Within two years from the date that your application was received by the Teacher Certification office, official transcripts and an Institutional Recommendation showing the completion of a teacher preparation program must be received by the Teacher Certification office. In addition, your transcripts must document the completion of 3 semester hours of approved Alaska Studies coursework and 3 semester hours of approved Alaska Multicultural coursework. Upon receipt of the transcripts and recommendation, your Initial certificate will be extended for one additional year. If you do not satisfy the Alaska Studies and Alaska Multicultural requirement or do not complete your teacher preparation program, your certificate will expire and you will not be eligible to teach in an Alaska public school nor apply for an additional Alaska teacher certificate. The endorsements on your Initial certificate will be the same as those listed on your Proof of Program Enrollment form. INITIAL/REEMPLOYMENT (1-year certificate) When your Initial/Reemployment certificate expires, you must meet all requirements for and apply for a Professional or Master teacher certificate. You will not be eligible for any other Alaska teacher certificate. The endorsements on your Initial/Reemployment certificate will be the same as those on your most recent Alaska teacher certificate. NOTARIZATION I have read the IMPORTANT NOTES concerning the Initial State of Date certificate for which I am applying. I understand the (MONTH/DAY/YEAR) requirements and timeline to keep my Initial certificate current and qualify for a Professional certificate. If I do not satisfy the ______________________ appeared before me whose requirements, I understand that I will no longer hold Alaska (NAME OF APPLICANT) teacher certification and will not be eligible to hold a certified teaching position in an Alaska public school. identification I have verified on the basis of _____________________ (TYPE OF PHOTO ID) I certify under penalty of perjury that the statements made by me in this application are true and correct to the best of my to be the signer of this application and he/she acknowledged that knowledge. Further, I acknowledge that I have read and will he/she signed it. adhere to the State of Alaska Code of Ethics of the Education Profession. This becomes part of my official (SIGNATURE OF NOTARY) record. My commission expires: SIGNATURE OF APPLICANT If a notary is not available, a Postmaster may witness, date stamp, and sign this affidavit. _______________________________________ DATE Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 10. TEACHER CERTIFICATION APPLICATION INITIAL CERTIFICATION Page 10 of 18 PROFESSIONAL CERTIFICATION REQUIREMENTS After obtaining an Initial teacher certificate, the next step in Alaska teacher certification is qualifying for a Professional teacher certificate. Read the following list and note the requirements that you still need to satisfy to gain a Professional teacher certificate. If you are currently able to satisfy all of these requirements, you should apply for a Professional teacher certificate instead of an Initial teacher certificate. The Professional application is available at http://www.eed.state.ak.us/teachercertification/forms/profess.pdf.  Passing scores on an approved Basic Competency Exam (e.g. Praxis I, CBEST, WEST- B, etc.)  An Institutional Recommendation and official transcripts showing the completion of an approved teacher preparation program -OR- A State Recommendation showing the completion of an approved teacher preparation program -OR- A Foreign Evaluation from an approved agency showing the completion of a teacher preparation program outside of the United States.  Official transcripts showing the completion of the following: • A Bachelor’s degree or higher from a regionally accredited institution, • Three semester hours of approved Alaska Studies coursework, • Three semester hours of approved Alaska Multicultural coursework, and • Six semester hours of college coursework within the last five years (recency credit). If the Alaska Studies course and Alaska Multicultural course were completed within the last five years, they will satisfy the recency requirement.  Two years of teaching experience while holding a valid teacher certificate  Passing scores on an approved content area exam (e.g. Praxis II)  A FD-258 fingerprint card with $66 processing fee or employment verification  Application fee--$125.00  A complete Professional teacher certificate application Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 11. TEACHER CERTIFICATION APPLICATION RECOMMENDATIONS & PROGRAM ENROLLMENT Page 11 of 18 You must submit an Institutional Recommendation, a State Recommendation, or a Proof of Program Enrollment form with your Initial application or have one on file with teacher certification. Use only the form that applies to your situation. If you completed a university teacher preparation program, submit the Institutional Recommendation with your application. If you completed a state-approved (non-university) program, submit the State Recommendation with your application. If you have not completed a teacher preparation program but are enrolled in one, submit the Proof of Program Enrollment form with your application. If you have completed a teacher preparation program outside of the United States, you will need to submit a complete, orginal foreign evaluation from an approved agency. More information concerning foreign evaluations can be found at http://www.eed.state.ak.us/teachercertification/forms/Foreign_Evaluation_Info.pdf. You may discard the forms that do not apply to your situation. _______________________________________________________________________________________________ APPLICANT DIRECTIONS: 1) Complete the APPLICANT INFORMATION section on both pages of the appropriate form. 2) Leave the remaining sections of the form blank. The university or state agency must complete all other sections. 3) Contact the university or state agency to determine who within the organization has the authority to verify the completion of or enrollment in a state-approved teacher preparation program. 4) If your teacher preparation program is at a university, mail or fax the form and the list of endorsements (p.12) to the Dean or Certification Officer within the university where you completed your program or where you are currently enrolled. -OR- If your teacher preparation program was completed in a state-approved (non-university) program, mail or fax the State Recommendation form and the list of endorsements (p.12) to the state official who has the authority to verify your completion of a state-approved alternate route to teacher certification. _______________________________________________________________________________________________ UNIVERSITY OR STATE AGENCY DIRECTIONS: 1) Provide all of the requested information in the following sections of the Institutional Recommendation, State Recommendation or the Proof of Program Enrollment form provided by the applicant: a. PROGRAM STANDARDS b. DEGREE INFORMATION c. ENDORSEMENT INFORMATION (INCLUDED IN THE ADMISSION INFORMATION ON THE PROOF OF PROGRAM ENROLLMENT FORM) d. SIGNATURE e. STAMP OR SEAL f. ADMINISSION INFORMATION (PROOF OF PROGRAM ENROLLMENT ONLY) 2) If a Stamp or Seal is not available, complete all information using blue ink. 3) Please return the original Institutional Recommendation, State Recommendation or the Proof of Program Enrollment form to the applicant. Photocopies/faxes will not be accepted. If you have any questions concerning the completion of the Institutional Recommendation, State Recommendation or the Proof of Program Enrollment form, please email tcwebmail@alaska.gov for assistance. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 12. TEACHER CERTIFICATION APPLICATION LIST OF ENDORSEMENTS Page 12 of 18 TEACHING ENDORSEMENTS Art Alaska Native Studies Business Art Alaska Native Studies Business Education Music Aleut Language/Culture Business Communication Music – Choral Athabascan Language/Culture Computer Education Music – Instrumental Haida Language/Culture Marketing Theater Arts Inupiaq Language/Culture Visual Arts Tlingit Language/Culture Yupik Language/Culture Early Childhood Educational Technology Elementary Education Early Childhood Education Educational Technology Elementary Education Special Ed – Early Childhood Languages Bilingual Education Language Arts Mathematics English as a Foreign Language English Mathematics English as a Second Language Language Arts Chinese Literature Middle School Japanese English Literature Middle School French Russian Literature German Communication Italian Speech Physical Education Latin Journalism Physical Education Russian Humanities Coaching Spanish Kinesiology Adaptive P.E. Reading Reading Science Reading Specialist Science Social Studies Remedial Reading Biology Social Studies Chemistry Anthropology Special Education Earth Science Economics Special Education Environmental Science Government Physically Handicapped General Science History Visually Handicapped Geology Political Science Hearing Impaired Health Social Science Learning Disability Life Science Sociology Emotionally Disturbed Natural Science U.S. History Cognitively Impaired Physical Science World History Communication Disorders Physics Russian History Multi-Handicapped Zoology Geography Resource Psychology Adaptive P.E. Library Special Ed – Early Childhood (Only available if applicant has Vocational Education completed a teacher preparation Vocational Education program.) Technology Education School Librarian Family/Consumer Science Library Science Industrial Arts Media Specialist Industrial Technology GRADE LEVELS Birth – Grade 3 Grades K-3 Grades 5-8 Grades 7-10 Grades 9-12 Pre K – Grade 3 Grades K-5 Grades 5-12 Grades 7-12 Pre K – Grade 12 Grades K-8 Grades K-12 Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 13. TEACHER CERTIFICATION APPLICATION INSTITUTIONAL RECOMMENDATION Page 13 of 18 This form should only be used if a standard, university teacher preparation program has been completed. APPLICANT INFORMATION This section is to be completed by the applicant before submission to the college/university. All other sections are to be completed by the preparing institution’s school of education. LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER MAILING ADDRESS CITY STATE ZIP CODE The remaining sections are to be completed by the preparing institution’s school of education, not the applicant. COLLEGE/UNIVERSITY INFORMATION Alaska certifies teachers who have completed approved university teacher preparation programs or state-approved teacher preparation programs. Please sign this form only if the candidate has completed a university teacher preparation program, which meets your state’s standards for teacher certification. All endorsements listed on this form must be based only on the completion of approved university programs. Your state’s requirements for certification and endorsements may vary from your approved program. Do not sign this form if the applicant has only met your state’s requirements for certification or endorsement, but has not completed the approved program. Deviations from your institution’s approved program may be acceptable, but require a formal rationale on university letterhead along with supporting documentation. PROGRAM STANDARDS DEGREE INFORMATION Specify which standards the approved program meets: Please specify the type of approved program completed:  NCATE  B.ED  MA  ED.D  STATE STANDARDS FROM AN NCATE PARTNERSHIP STATE  BS  MS  PH.D  STATE STANDARDS FROM AN NON-NCATE PARTNERSHIP STATE  BA  MAT  NO DEGREE/CERTIFICATION ONLY  NASDTEC  M.ED  OTHER ________________  OTHER ________________ ENDORSEMENT INFORMATION Please refer to the “List of Endorsements” before entering any information. All endorsements listed below must be included on the attached list of endorsements. If the list of endorsements is not provided to you by the applicant, please contact Teacher Certification for available endorsements. GRADE YEAR OF GRADE YEAR OF CONTENT AREA CONTENT AREA LEVEL(S) COMPLETION LEVEL(S) COMPLETION 1. __________________ ___________ ____________ 4. ____________________ ___________ ____________ 2. ____________________ ___________ ____________ 5. ____________________ ___________ ____________ 3. ____________________ ___________ ____________ 6. ____________________ ___________ ____________ By signing below, I verify that the applicant has met all institutional requirements for the approved programs (as defined above) in the areas listed below. In addition, I verify that the applicant maintained ethical standards required of an educator while attending the institution. SIGNATURE OF DEAN OR CERTIFYING OFFICIAL PRINTED NAME TITLE DATE -CONTINUED ON NEXT PAGE- Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 14. TEACHER CERTIFICATION APPLICATION INSTITUTIONAL RECOMMENDATION Page 14 of 18 This form should only be used if a standard, university teacher preparation program has been completed. APPLICANT INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER SIGNATURE NAME OF INSTITUTION CITY STATE REGIONAL ACCREDITING ASSOCIATION SIGNATURE OF DEAN OR CERTIFYING OFFICIAL PRINTED NAME TITLE DATE - - - - PHONE NUMBER FAX NUMBER EMAIL ADDRESS STAMP OR SEAL COLLEGE STAMP OR SEAL – IF NOT AVAILABLE, FORM MUST BE SIGNED IN BLUE INK Please return the Institutional Recommendation to the applicant. Photocopies/faxes will not be accepted. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 15. TEACHER CERTIFICATION APPLICATION PROOF OF PROGRAM ENROLLMENT Page 15 of 18 This form cannot be used for individuals enrolled in special education programs. Those individuals must complete their program prior to applying for initial certification. APPLICANT INFORMATION This section is to be completed by the applicant before submission to the regionally accredited college/university. All other sections are to be completed by the preparing institution’s school of education. LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER MAILING ADDRESS CITY STATE ZIP CODE The remaining sections are to be completed by the preparing institution’s school of education, not the applicant. ADMISSION INFORMATION 1. Has the applicant been admitted to an approved teacher education program, leading to certification? YES NO 2. What is the applicant’s anticipated program completion date? _______________________ (MM/DD/YYYY) 3. How many credits of the approved program has the applicant completed? ____________ CREDITS 4. How many total credits are in the approved program? ____________ CREDITS 5. The applicant is currently enrolled in a program leading to certification in the area(s) listed below: CONTENT AREA GRADE LEVEL(S) CONTENT AREA GRADE LEVEL(S) 1. ______________________________ ____________ 3. ______________________________ ____________ 2. ______________________________ ____________ 4. ______________________________ ____________ NOTE: This form cannot be used for individuals enrolled in special education programs. Those individuals must complete their program prior to applying for the Initial certificate. PROGRAM STANDARDS Specify which standards the approved program meets:  NCATE  NASDTEC  STATE STANDARDS FROM AN NCATE PARTNERSHIP STATE  STATE STANDARDS FROM AN NON-NCATE PARTNERSHIP STATE OTHER: _____________________ DEGREE INFORMATION BA MAT M.ED NO DEGREE/CERTIFICATION ONLY Please specify the type of program enrollment: BS MA ED.D OTHER: _____________________ B.ED MS PH.D -CONTINUED ON NEXT PAGE- Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 16. TEACHER CERTIFICATION APPLICATION PROOF OF PROGRAM ENROLLMENT Page 16 of 18 This form cannot be used for individuals enrolled in special education programs. Those individuals must complete their program prior to applying for initial certification. APPLICANT INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER SIGNATURE NAME OF INSTITUTION CITY STATE REGIONAL ACCREDITING ASSOCIATION SIGNATURE OF DEAN OR CERTIFYING OFFICIAL PRINTED NAME TITLE DATE - - - - PHONE NUMBER FAX NUMBER EMAIL ADDRESS STAMP OR SEAL COLLEGE STAMP OR SEAL – IF NOT AVAILABLE, FORM MUST BE SIGNED IN BLUE INK Please return the Proof of Program Enrollment to the applicant. Photocopies/faxes will not be accepted. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 17. TEACHER CERTIFICATION APPLICATION STATE RECOMMENDATION Page 17 of 18 Do not use this form if you have completed a teacher preparation program through a university or college. This form should be completed only if the individual has completed an approved alternate program to certification. APPLICANT INFORMATION This section is to be completed by the applicant before submission to the state department of education. All other sections are to be completed by the preparing state’s commissioner of education. LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER MAILING ADDRESS CITY STATE ZIP CODE The remaining sections are to be completed by the preparing state’s chief state school officer or certifying official, not the applicant. STATE INFORMATION Alaska certifies teachers who have completed approved university teacher preparation programs or state-approved teacher preparation programs. Please sign this form only if the candidate has completed a state-approved teacher preparation program which meets your state’s standards for teacher certification. Please do not sign this form if the alternate program was based solely on transcript analysis and testing. All endorsements listed on this form must be based only on the completion of state-approved programs. Do not include endorsements based only on testing alone. If the candidate has completed an approved university teacher preparation program, the preparing university must complete an institutional recommendation, not this state recommendation. PROGRAM STANDARDS DEGREE INFORMATION Specify which standards the state-approved program meets: Please specify the type of state-approved program completed:  NCATE  B.ED  MA  ED.D  NASDTEC  BS  MS  PH.D  STATE  BA  MAT  NO DEGREE/CERTIFICATION ONLY  OTHER: _______________________________  M.ED  OTHER ________________ PLEASE SELECT ONE OF THE FOLLOWING:  COMPLETED STUDENT TEACHING  COMPLETED MENTORED/SUPERVISED TEACHING  REQUIREMENT WAIVED FOR SATISFACTORY EXPERIENCE ENDORSEMENT INFORMATION This state verifies that the applicant has met all state requirements for the approved state approved program(s) in the areas listed below. Do not include endorsements based only on testing. GRADE YEAR OF GRADE YEAR OF CONTENT AREA CONTENT AREA LEVEL(S) COMPLETION LEVEL(S) COMPLETION 1. ____________________ ___________ ____________ 4. ____________________ ___________ ____________ 2. ____________________ ___________ ____________ 5. ____________________ ___________ ____________ 3. ____________________ ___________ ____________ 6. ____________________ ___________ ____________ By signing below, I verify that the applicant has met all l requirements for the state approved programs (as defined above) in the areas listed. In addition, I verify that the applicant maintained ethical standards required of an educator while attending the institution. CERTIFYING OFFICIAL PRINTED NAME TITLE DATE -CONTINUED ON NEXT PAGE- Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11
  • 18. TEACHER CERTIFICATION APPLICATION STATE RECOMMENDATION Page 18 of 18 Do not use this form if you have completed a teacher preparation program through a university or college. This form should be completed only if the individual has completed an approved alternate program to certification. APPLICANT INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL SOCIAL SECURITY NUMBER SIGNATURE STATE SIGNATURE OF STATE OFFICIAL PRINTED NAME TITLE DATE - - - - PHONE NUMBER FAX NUMBER EMAIL ADDRESS STAMP OR SEAL STATE STAMP OR SEAL (IF AVAILABLE). IF NOT AVAILABLE, FORM MUST BE SIGNED IN BLUE INK Please return the State Recommendation to the applicant. Photocopies/faxes will not be accepted. Department of Education & Early Development, Teacher Education and Certification 801 West 10th Street, Suite 200, PO Box 110500 Juneau, AK 99811-0500 Phone: (907) 465-2831 Fax: (907) 465-2441 Initial www.eed.state.ak.us/teachercertification tcwebmail@alaska.gov 11/17/11