/1 Form 70-8 Application Procedures.. Georgia Professional Standards Commission Certification Section 1452 Twin Towers East Atlanta, Georgia 30334 Form 70-B (Application for Certification, Long Forml is to be used for the following transactions: Application for First Georgia Certificate (Conditional or Clear Renewable) Application to Upgrade to a Higher Certificate Level Application to Add a Field to a Georgia Certificate Application for Conditional Certificate Fields (Provisional, Emergency, Probationary In-Field, One-Year Professional, Nonrenewable) Application to Convert Conditional Certificate Fields to Clear Renewable Status If you are applying for renewal of a Clear Renewable Certificate field, a name change on a valid Georgia certificate, a duplicate of a valid Georgia certificate, a teaching permit, or for an evaluation for certification, you should contact the Professional Standards Commission, Certification Section, for the correct forms and instructions for these transactions. If you attended a college outside the United States, you should contact the Certification Section for additional information before submitting your application. The Certification Section utilizes a complete package application procedure. The application is considered complete when all required, signed documentation and fees have been received. It is the responsibility of the applicant to submit a complete package. If a transcript is being sent directly to the Certification Section by the college, the application package will be held for 30 days, at which time the incomplete package will be returned for correction or completion. If a transcript is being sent directly to the Certification Section by the college, you should check the appropriate box in item 3 on the front of Form 70-B. Please read the information that follows and the instructions printed on the back of Form 70-B and all accompanying forms carefully before submitting your application. A. Application for Certification Based on a College Approved Program {Rule 505-2-.061 To make application for the first Georgia certificate or any additional certificate based upon completion of a college's approved education preparation program, the following forms and records must be submitted to the Certification Section in a complete package. 1. Application Form 70-B (Long Form) 2. College Recommendation Form 71 from each college where an education preparation program was completed. If the applicant currently holds a Georgia certificate, Form 71 needs to be submitted for programs completed since the last Georgia certificate was issued. 3. Official transcripts from each college attended with imprinted college or university seals or special seals used by the institution for certification purposes. Transcripts must bear the stamp or signature of the institution registrar and must include course numbers, titles, grades and credit earned, as well as a degree statement and degree date that specifies the month, day, and year of each degree awarded. If you currently hold a Georgia certificate, submit only transcripts for credits completed since the last Georgia certificate was issued. Applications with unofficial transcripts will be returned unprocessed. 4. Verification of any teaching or school experience completed within the last five years on Form 0005. 5. A legible photocopy (front and back) of any out-of-state certificate valid within the last five years. B. Application for Certification Based on Out-of-State Certification (Rule 505-2-.151 To make application for certification based upon holding or having held a valid professional certificate issued by another state, the District of Columbia, DODDS or U.S. Territory, the following forms and records must be submitted to the Certification Section in a complete package. 1. Application Form 70-B (Long Form). 2. Official transcripts from each college attended with imprinted college or university seals or special seals used by the institution for certification purposes. Transcripts must bear the stamp or signature of the institution registrar and must include course numbers, titles, grades and credit earned, as well as a degree statement and degree date that specifies the month, day, and year of each degree awarded. If you currently hold a Georgia certificate, submit only transcripts for credits completed since the last Georgia certificate was issued. Applications with unofficial transcripts will be returned unprocessed. 3. Verification of any teaching or school experience completed within the last five years on Form 0005. 4. A legible photocopy (front and back) of any professional certificate(s} held or previously held in another state, District of Columbia, DODDS or U.S. Territory. C. Application for Certification Based on Evaluation by the Certification Section (Rule 505-2-.07) To make application for certification based upon completion of an evaluation prepared by the Certification Section, the following forms and records must be submitted in a complete package. 1. Application Form 70-B {Long Form}. 2. Official transcripts from each college attended with imprinted college or university seals or special seals used by the institution for certification purposes. Transcripts must bear the stamp or signature of the institution registrar and must include course numbers, titles, grades and credit earned, as well as a degree statement and degree date that specifies the month, day, and year of each degree awarded. If you currently hold a Georgia certificate, submit only transcripts for credits completed since the last Georgia certificate was issued. Applications with unofficial transcripts will be returned unprocessed. 3. A legible photocopy of the evaluation for certification prepared by the Certification Section within the last 3 years. Please note that effective 7-1-93, the Certification Section no longer evaluates for the first professional certificate. Applicants must have completed a college approved program or must hold or have previously held professional certification from another state. Any evaluation for the first professional certificate field that was completed both within three years from the date of the evaluation and within three years from the date of certificate application will continue to be recognized for Georgia certification. D. Appli~tioR for Certification Upgrade to Higher Level, Additional Fields or Endorsements, Conditional Certificate Fields and Conversion of Conditional Fields to Clear Renewable Status. To make application for a certificate upgrade to a higher level, the addition of certificate fields or endorsements, conditional certificate fields (provisional, emergency, probationary) and for conversion of conditional certificate fields to clear renewable status, the following forms and records must be submitted to the Certification Section in a complete package. 1. Application Form 70-B (Long Form) 2. College Recommendation Form 71 (if applicable) for a certificate upgrade or additional field that was satisfied through completion of a college's approved education preparation program. 3. Official college transcripts and Staff Development Unit transcripts for coursework completed since the last Georgia certificate was issued. 4. Verification of any teaching or school experience (if applicable) if experience is being used in lieu of a practicum or internship requirement, if the certificate application is based upon the applicant having a Life status certificate in Georgia or if the certificate field requested requires documentation of specific experiences. E. Additional Forms for Certification To make application for certification in Audiology, Vocational Education fields (based upon occupational experience) and for Level Six Certification based upon the Alternate Plan for doctoral degree candidates, additional forms must be submitted with the application package. Please contact the Certification Section for the forms required for these transactions. F. Application Fee Certain certification transactions require a fee. If a fee is applicable to your transaction, you must submit a Money Order or Cashier's Check made payable to The State of Georgia in the amount required for your transaction. An application transaction submitted on Form 70-B requires a fee of $20, unless one of the following exemptions applies. 1. The applicant has held no prior Georgia certification and the applicant completed an approved education preparation program from a Georgia college. 2. The applicant has held no prior Georgia certification, is now applying for professional or provisional certification, and is employed in a Georgia public or private school or state agency. 3. The applicant requests an upgrade to clear renewable certificate fields, an upgrade to a higher degree or certificate level, or the addition of a certificate field or endorsement to an existing certificate, and the applicant is employed in a Georgia public or private school or state agency. G. Special Georgia Requirements All applicants for certification in Georgia must satisfy certain Special Georgia Requirements. (These requirements do not apply to individuals maintaining valid Life Georgia certification.) An applicant who qualifies for professional certification in Georgia but lacks one or more of the special requirements can receive a conditional one-year certificate upon the request of a Georgia employer. If the applicant lacks a special requirement and is not employed in Georgia, no certificate will be issued until the applicant is either employed or has satisfied all special requirements. All application materials will be returned with a letter of eligibility. Special Georgia Requirements include the following. 1. Special Education (O.C.G.A 20-2-201). Any person certified in a teaching field, the leadership field of Administration and Supervision and/or the service fields of Media Specialist and School Counselor must complete 5 quarter hours of college credit, or the equivalent through a Georgia approved staff development program, in the identification and education of children with special education needs. 2. Teaching of Reading. Any person certified in one of the fields of Elementery Educetion, Early Childhood Education, Middle Grades, Mental Retardation, Learning Disabilities, Behavior Disorders, Interrelated Special Education, Interrelated Special Education/Eerly Childhood or English must complete 5 quarter hours of college credit, or the equivalent through a Georgia approved staff development program, in the Teaching of Reading. 3. Teacher Certification Test (TCn. An applicant must post a qualifying score on the appropriate subject matter Teacher Certification Test (TCT) or the Netional Occupational Competency Testing Institute (NOClI) Exam (for certain vocational/technical fields). Please note that applicants for provisional certification who do not have a state letter of evaluation or eligibility before 6-30-93, applicants for emergency certification with expired Georgia certificates and applicants who complete approved education preparation programs from Georgia colleges after 7-1-93 must satisfy the certification test before receiving a certificate in Georgia. These applicants cannot receive a conditional one-year certificate. 4. Recency of Study. An applicant for professional certification must meet recency of study by earning a minimum of 10 quarter hours of acceptable college credits, or the equivalent through a Georgia approved staff development program, within 5 years prior to the date of the application, by teaching out of state for one full year within five years prior to the date of the application on a valid out-of-state certificate or by teaching full time at an accredited college for one year within five years prior to the date of the application. H. General Information Application for certification may be made as soon as all requirements for a certificate have been completed during the year in which the applicant expects to use the certificate. All correspondence to the Certification Section must include the social security number of the applicant. Transcripts and other records from which a certificate is issued will not be returned to the applicant, nor can copies be made of transcript records retained in the Certification Section. Incomplete application packages or application records from which no certificate is issued are returned to the applicant. Questions about forms or procedures may be directed to the Professional Standards Commission at 404-657-9000. Outside the Metro Atlanta area (in Georgia only), you may call 800-736-4322 or 800-869-7775. Evaluators may accept calls from the applicant between 1:00 P.M. and 4:30 P.M. Form 70B Procedures Revised June 1993 Type of Transaction Requested State Use Only First Georgia Certificate Upgrade to a Higher Level Add Fields Application for Certification Georgia Professional Standards Commission Certification Section 70 B Long Form Conditional Certificate Fields 1452 Twin Towers East Convert Conditional Field to Clear Renewable Status Atlanta, Georgia 30334 Type or print In black Ink. Please read the Instructions on the back of this form carefully before completing the appllcetlon. 1. Social Security Number 1!::-~ --r-:-.r-:-_-;--r-...,.-~ Date of Birth Phone Number I_M_O_: D_aY_: Y_r_: I_( --J 2. Name and Address Information . Title - Check the appropriate space Last Name First Middle Malden Miss Mrs. Ms. Mr. Dr. Other The name on my certificate should be: Street Name and Number: Box, Route, Apartment Number: City, State, Zip Code: .. 3. Acedemlc Record - Submit offiCial transcripts from all colleges attended. Attach an additional sheet If needed. College, City, State Dates Attended Degree/Major Check One Transcript AttlIched Transcript Being Sent 4. Personal Affirmation - Answer each question yes or no. Exclude events before age 16. Have you been discharged from any position or the armed forces for unprofessional conduct? Have you had a teaching credential denied, revoked or suspended in any state? Have you been convicted of a misdemeanor other than a minor traffic offense? Have you been convicted of a felony? Yes No Knowing that false statements made in this application may constitute sufficient grounds to revoke or deny a certificate, I affirm that to the best of my knowledge all information is true and correct. I understand the requirements involved with any certification which my employer is requesting and that renewal credit and/or test requirements must be met for continued certification. I also understand that my Social Security Number will become my certificate number and this number will be shared with other states and other agencies in the event that any disciplinary action affecting my certification occurs. 5. FEE - Signoture: Money Order or Cashier,sCheck poytlble to The Stole of GeOrgul. DDt'll: Cash and perso1Ull checks will not be aecepted. $20 Money Order or Cashier's Check Enclosed Emp 'Yer s ssurance (reqUUtJ or 'tie exem ns Beginning an , 19 __, this applicant has been employed by the schaol system/agency shown below as educator in the field of and assigned in the school/agency. The school system/agency requests the following conditional certification. _ Provisional (8) Field _ AppropriateTCT has been passed. _ Emergency (E) Field _ Appropriate TCThas been passed. _ Probationary In-Field (PA) Field _ _ One-year Professional Field _ _ The applicant is exempt from aPplication fee because of exemption # from the instructions on the reverse side. Knowing that false statements of undocumented assurance may constitute sufficient grounds to revoke or deny a certificate, I affirm the following: The applicant is employed in the school system/agency shown here, the applicant is the best qualified applicant available for any conditional certificat field requested, and in requesting any conditional certificate field, the applicant has been informed ofpossible outstanding requirements that must be completed during the validity period of the certificate field requested to establish eligibility for recertification. Superintendent or Designee: _ Date: _ School System/Agency: System/Agency Code: Certificate Authorized FOR STATE SE ONLY Fee Amount: TypelTitle Field(s) Date: Evaluator: Completed: Fee Receipt Refund Approved: ___ Disposition Code and Instructions (from) Validity Dates (to) Form 70B (Long Form). ReVised June 1993 Reference Number Instructions for Form 70 B Long Form Appllcetlon for Certlflcetlon Please read the instructions on this page carefully before completing the application. Refer to 70-8 Application Procedures for additional information. The Professional Standards Commission utilizes a complete package application procedure. The application is considered complete when all required signed documentation and fees have been received. It is the responsibility of the applicant to submit a complete package. If a transcript is being sent directly to the Certification Section by the college, the application package will be held for 30 days, at which time the incomplete package will be returned for correction or completion. If a transcript is being sent directly to the Certification Section by the college, you should check the appropriate box in item 3 on the reverse side. Questions about this form or procedures may be directed to the Professional Standards Commission at 404-657-9000. Outside the Metro Atlanta area (in Georgia only), you may call 800-736-4322 or 800-869-7775. Evaluators may accept calls from the applicant between 1:00 P.M. and 4:30 P.M. Reference numbers In thase instructions correspond to the item numbers on the front of this application form. Type of Transaction Requested First Georgia Certificate Check this item if you have never held a Georgia educator certificate before. Upgrade to a Higher Level Check this item if you hold a Georgia certificate and are now requesting a higher level (for example you now hold a level 4 certificate and you are applying for level 5.) Add Fields Check this item if you hold Georgia certification and would like to add another field. List the field(s) for which you are seeking certification. Conditional Certificate Fields Check this item if you are applying for a conditional certificate field (provisional, emergency, probationary, one-year professional, nonrenewable). Convert Conditional Field to Check this item if you hold a Georgia conditional certificate field that you are converting to Clear Renewable Status clear renewable status. Note: You mu.t .ubmit an expemnce verjkaJion Form 0005 ifyou are reque.ting certificaJion in any of the foUowing field.: AdministraJion and Supervision, School NutrlJion Director, School Coun.eling, Teacher Support Specialist, Gffted (ProbaJionary), School P.ychology, or if you are reque.ting an upgrade or addition to a Life cef1i/icalion. 1. Your social security number will be your certificate number. Print the number accurately and legibly. Your date of birth is requested for identification purposes. 2. List your complete legal name and the address where your certificate should be mailed. Also include the name you wish to appear on the certificate. 3. Acedemlc Record - You must submit offlclel transcripts with imprinted college or university seals or special seals used by the institution for certification purposes. Transcripts must bear the stamp or signature of the institution registrar and must include course numbers, titles, grades and credit earned, as well as a degree statement and degree date that specifies the month, day and year of each degree awarded. If you currently hold a Georgia certificate, submit only transcripts for credits completed since the last Georgia certificate was issued. Appllcetlons with unofflclel transcripts will be returned unprocessed. High school transcripts or a copy of a high school diploma are required only if this application is being made for an initial vocational-technical certificate for which no college or vocational training is being submitted. Notes: If you attended an institution outside the United States, contact our office for additional information before submitting this form. If you are applying for your first Georgia certificate and hold an out-of-state certificate, or if you have taught in an accredited college during the last five years, you must include a completed Form 0005 with this application along with copies of any out-of-state certificates you hold. 4. Personel Affirmation - You must complete this section by checking either Yes or No for each question. If you do not answer all questions in this section, the form will be returned unprocessed. You must also sign and date the form. 5. Fees - The $20 transaction fee is welved If you meet eny condition below. Exemption # 1 This is your first Georgia certificate end you have completed an approved education preparation program from a Georgia college. Exemption # 2 This is your first Georgia certificate and you are employed in a Georgie public or private school or state agency. Employment must be verified by the superintendent or designee on the front of this form. Exemption # 3 You are upgrading to a higher certificate level and you are employed in a Georgie public or private school or state agency. Employment must be verified by the superintendent or designee on the front of this form. Exemption # 4 You are adding a professional certlflcetlon field and you are employed in a Georgie public or private school or state agency. Employment must be verified by the superintendent or designee on the front of this form. Exemption # 5 You are converting from a condltlonel to a clear renewable certificate field and you are employed in a Georgie public or private school or state agency. Employment must be verified by the superintendent or designee on the front of this form. For ell other requests made with this form, Include a $20 Money Order or Ceshler's Check peyable to The Stete of Georala. 6. Employers Assurences - This section Is used to verify employment, verify fee exemption, end request conditioneI certificate fields. For conditional certficate fields your employer must make application with you jointly and must confirm your employment by completing the Employer's Assurances section. Types of Condltlonel Certlflcetes Provlslonel. The applicant has satisfied entry level requirements for provisional certification (including a passing score on the Georgia TCT if applicable) but has not completed all requirements for the professional certificate. One-Veer Professlonel. The applicant has completed an out-of-state education preparation program (or a Georgia preparation program completed before 7-1-93) but has not yet passed the TCT and/or has not satisfied all Georgia special course requirements. Emergency. The applicant lacks recency of study requirments. (If the applicant was previously certified in Georgia, the TCT in the certificate field must have been passed before emergency can be issued.) Probetlonery In-Field. The applicant will be employed out of his/her field of professional certification. The requested probationary field must be shown on the application. College Recommendation for Certification Georgia Professional Standards Commission Certification Section 1452 Twin Towers East Atlanta, Georgia 30334 Complete this form In type or dark Ink. Please read the Instructions on the back before completing this form. Section I (To be completed by the applicant) CCIIJ Social Security Number [ I I ] - [ ] ] - Last Name First Middle Other Names Date of Birth Address (Street and Number, Box or Route) City State Zip Code Degree and Date Conferred (or Date to be Conferred) Major(s) Section II (To be completed by the designated college certification official for each education preparation program completed and returned to the applicant) A. Professionally Recommended 1. On , the applicant, -----,=:-::r==------' completed all requirements for the MolIth, Day, Year Name ofAPplicant approved education preparation program in the following area(s): -----r:=.......- - - - - - - - - - - - AreG(s} _ _ _ _ _ _ _ _ _ _ _ _ and was (or will be) awarded the degree on ----,~r""ft="'!~-- Moiit1l; DCijI, Year If the degree has not been formally awarded, attach a lener from the Registrar stating when degree requirements were met. 2. On --nM=o.n.t.h.,."v.a".y....r"e,a,:r::::--, the applicant, ==:"...."..==.---- NQIfle oj AjJpactiiJ , completed all requirements for the approved education preparation program in the following area(s): _ _~=~----------- Area{s) _ _ _ _ _ _ _ _ _ _ _ _ _ but was NOT awarded a degree from this institution. 3. The applicant's preparation program Included student teaching, Internship or practlcums In the following area(s): and at the following grade level(s): . For special education applicants, please designate the exact area(s) of exceptionality (MR, LD, etc.) in which student teaching, internship or practlcum was completed. 4. The applicant completed a Georgia approved education preparation program and posted a passing score on the Teacher Certification Test (TCT) in the field of B. Not Professionally Recommended Test Field on _ MolIth, Day, Year 1. The applicant, -', was (or will be) awarded the degree on at this institution but did not complete an approved education preparation program. 2. The applicant is not recommended for certification for the following reason(s): _ This is to confirm that the preparation program offered by this institution was approved in the field(s) and at the level(s) for which this applicant is being recommended and that the approved program was in effect during the time of the applicant's enrollment. Check all accreditations which apply. o NCATE o State o Regional o NASP (School Psychologist) Signature of Designated College Certification Official Date For State Use Only Affix school seal here. Title or Position College or University Fonn 71, ReYlMd June 1993 Reference Number Instructions for College Recommendation for Certification Form 71 This form is to be completed for applicants for Georgia certification whose application is based upon completion of an approved education preparation program. A separate college recommendation form is required from each college where an approved preparation program was completed. It is the responsibility of the applicant to secure the recommendation for certification from the designated college certification official. The completed form should be attached to Application for Certification Form 70-8 (Long Form) and submitted to the Professional Standards Commission, Certification Section along with official college transcripts, the application fee (when applicable) and all other documents necessary to apply for certification in Georgia (see Form 70-8 Application Procedures). Section I must be completed by the applicant to identify the Social Security number, complete legal name of the applicant (last, first, middle, maiden and previously married name) and the current mailing address of the applicant. Section II must be completed by the designated college certification official to confirm that the applicant completed an approved education preparation program at the college. It is the responsibility of the college official to indicate the date program requirements were completed and the exact field(s) of certification for which the approved program was designed. Item 1 allows the college certification official to confirm that a degree was or will be conferred by the college upon completion of the education preparation program. If the degree has not been formally awarded, a letter from the Registrar must be attached stating when degree requirements were met. Item 2 allows the college certification official to confirm that the applicant completed an approved education preparation program after having already earned a degree at the college or some other college. Item 3 must be completed by the college certification official to identify the specific field(s) and grade level(s) in which student teaching, internship and/or practicum experience was completed. If the recommendation is for special education, the exact area(s) of exceptionality (MR, LD, etc.) must be identified. Item 4 must be completed by the college certification official if the applicant completed an approved education preparation program from a Georgia college after 7-1-93. Part B of Section II is completed by the designated college certification official if the applicant did not complete an approved education preparation program at the college or is not being recommended for professional certification. The college recommendation must be signed by the designated college certification official to confirm that the education preparation program was approved for the field(s) for which the applicant is being recommended at the time the applicant completed the program. All appropriate boxes must be checked to confirm the accreditation status of the program at the time the applicant was enrolled. The school seal or notary stamp must be affixed to the recommendation form in the designated space. Questions about this form or procedures may be directed to the Professional Standards Commission at 404-657-9000. Outside the Metro Atlanta area (in Georgia only), you may call 800-736-4322 or 800-869-7775. Evaluators may accept calls from the applicant between the hours of 1:00 P.M. and 4:30 P.M. . Georgia Professional Standards Commission Certification Section -1452 Twin Towers East - Atlanta, Georgia School Experience Verification Form 30334 Part I. To Be Completed by Applicant Applicant must submit a copy of the valid certificate held when the experience was earned. Employee's Name _ Social Security Number Birth Date _ Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Zlp Code _ Part II. To Be Completed by the SChool Superintendent of the School District/SChool In which the Experience was Earned 1. For experience earned prior to the 1976-n school year, list only those days the teacher actually taught while students were In school. 2. For experience earned In a private school, please attach a brief desaiptlon of the school, I.e., type of curriculum, grade andlor age levels of InstnJcllon and accreditation status. 3. College teaching must be vertfied by the president, bursar, or comptroller of the college and must specify academic rank held. Use one line for each academic year or change In status. Do not Indude leave of absence periods. School DIstrIct AND School Name State Dates 01 Servloe SCHOOL Accreditation ...rom TO Status During the Dates Mo{Day(Yr Mo(Day(Yr 01 ServIoe,lndlcate Yes{No & Type Days In Fun Contract Contract Days Year Employed Status Hours Full Part Per Time Time Day Position Grades and Subjects Professional Taught Major certification PortIon 01 Time Yes(No & Type I certify that the ab0v9-listed verification ofprofessional experienoe omits I8IJve of BbsefJC8 periods. I further certify that all infoImation listed above is complete and COIT9Ct according to the offfclBl f'8aXds on file In the school system or Institution providing this verification of employment. Signature 01 SUperintendent or Authorized 0fIIcIaI TIlle Fonn 0001, RftIRcI December 1..., Date Street Address CIty, State end Zip Code "special education was taught, please identify 1he exact type 01 handicap I8MId 0.8. BD, LD, MR, etc.)