Ancillary Application Form PDF Details

The journey to obtaining a Louisiana ancillary certificate involves navigating through a comprehensive application process, tailored to assist individuals who have specialized degrees or credentials and are seeking certification in various domains such as education, artist, audiologist, behavior analyst, and more. This process outlined in the Ancillary Certification Application Packet offers clarity and guidance for prospective ancillary teachers or service providers. It is important to note that this packet caters to a wide array of certifications excluding Ancillary Early Childhood certification, which has a dedicated process. Applicants are required to submit a complete application packet via the online educator certification portal, including the application form duly completed and signed, official transcripts from all attended universities or colleges, and, if applicable, a copy of valid licensure. Additionally, there might be a need for an Experience Verification form or letter, a Professional Conduct form, and the payment of a certification processing fee, which varies depending on whether it's an initial certification or a renewal, with some certificate types like Ancillary Mentor Teacher and Content Leader exempt from this fee. Importantly, this intricate process aims at a streamlined certification experience, ensuring applications are evaluated systematically and allowing applicants to track the status of their certification application through a dedicated online platform.

QuestionAnswer
Form NameAncillary Application Form
Form Length7 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 45 sec
Other namesancillary certification packet, louisiana ancillary certification, louisiana ancillary certification application, ancillary certificate

Form Preview Example

Application Type - AN

ANCILLARY CERTIFICATION APPLICATION PACKET INSTRUCTIONS

Dear Prospective Louisiana Ancillary Teacher/Service Provider:

We are pleased that you are interested in obtaining a Louisiana ancillary certificate. The instructions outlined in this application packet are designed to facilitate the process of obtaining a Louisiana ancillary certificate to applicants holding degrees or credentials in a specialized area. The guidelines for each type of ancillary certificate are included in this packet. This application packet does not include Ancillary Early Childhood certification; there is a separate ancillary application packet for early childhood certification requests.

Submitting application: Please submit a complete application packet (including required documentation as listed within the “Ancillary Certificate Type” chart on pages 2-5) to the online educator certification portal. The following items are required as part of a complete application packet:

Application for Ancillary Certificate form with all information provided and signed by appropriate persons (Directions on the following pages indicate when the application must be signed/submitted by a Louisiana Employing School System.)

Transcripts - from ALL universities/colleges attended, sent (mailed or emailed) directly to teacher candidate, the employing school system, or the program provider, as those will be considered official. Scan, insert, and upload to TeachLALive! (https://ldoe.force.com/s/) with the certification application.

Copy of Valid Licensure (if applicable; e.g. nursing license, counseling license, etc. Directions on the following pages indicate what license is required for each of the ancillary areas offered.)

Experience Verification form or letter of verification signed by the appropriate employing authority if applicable according to the directions on the following pages aligning with the ancillary area requested

Professional Conduct form with all questions answered, signed, and dated by the applicant

Certification Processing Fee - (Submit online payment confirmation screenshot or email) Initial Ancillary - $50.00 -or- Renewal of Ancillary $25.00 - payable online at

https://www.billerpayments.com/app/simplepayui/?bsn=sladoeteachcert

Please note: Ancillary Mentor Teacher and Ancillary Content Leader certification does NOT require a fee. Please do NOT submit a payment for those certificate types as the payment system does not permit refunds.

Contact Information: All questions regarding certification requirements or the certification process, can be answered by submitting your question to the certification office via the online educator certification portal.

All applications will be evaluated in the order in which they are received. You can check the status of your certification application online HERE.

Rev. October 1, 2020

pg. 1

ANCILLARY CERTIFICATE TYPES

CERTIFICATION AREA

DOCUMENTATION REQUIRED

Artist (Art, Creative Writing, Drama, Dance,

Application signed & submitted by LA Employing School System or some type of verification

Music, Theatre, or Visual Arts)

 

from system that applicant will be employed to teach specific art area

(Valid 5 years – renewable with effective

Evidence of substantial professional recognition (e.g., letters from representatives of the arts

Compass evaluations)

 

community, gallery directors, art center directors, reporters)

 

Evidence of substantial artistic or creative accomplishments (e.g., newspaper articles,

 

 

programs, playbills, published music scores, brochures, invoices for commissioned work,

 

 

etc.) Photos, slides and actual artwork are not acceptable

Art Therapist

Application signed & submitted by LA Employing School System

(Valid as long as individual remains in same

Transcripts showing the completion of an Art Therapy degree program*

system)

Copy of registration from American Art Therapy Association

 

Verification of pre-clinical experience

Audiologist-Provisional

Application signed & submitted by LA Employing School System

(Valid 3 years, nonrenewable)

Official transcripts showing a master’s degree* in audiology

 

Verification that applicant will work under the supervision of a licensed audiologist

Audiologist-Qualified

Official transcripts showing a master’s degree* in audiology

(Valid as long as holder maintains a current LA

Copy of current Louisiana licensure as an Audiologist

Audiologist license)

 

 

 

Behavior Analyst - Assistant

Application signed & submitted by LA Employing School System

(Valid as long as license is valid)

Hold a bachelor’s degree*

 

Copy of valid assistant level Behavior Analyst Certification Board (BACB) or Comprehensive

 

 

Application of Behavior Analysis to Schooling Board (CABAS).

 

Must have direct supervision.

Behavior Analyst

Application signed & submitted by LA Employing School System

(Valid as long as license is valid)

Hold a master’s degree*

 

Copy of valid assistant level Behavior Analyst Certification Board (BACB) or Comprehensive

 

 

Application of Behavior Analysis to Schooling Board (CABAS).

Child Nutrition Program Supervisor

Application signed & submitted by LA Employing School System

(Valid for life with continuous service for

Letter from employing school system verifying student enrollment

period/place of employment)

Completion documentation verifying the completion of 8 hours of food safety training

 

Transcripts* with qualifying education in alignment with eligibility requirements for employing

 

 

school system’s student enrollment

Child Nutrition Program Supervisor

Application signed & submitted by LA Employing School System

Provisional

Bachelor’s or Master’s degree*

(Valid for school year; renewable annually)

Special certificate can be issued to an applicant serving in this capacity with the

 

 

understanding that six (6) semester hours are completed each year for renewal

Child Search Coordinator

Must hold valid ancillary certificate for social worker, speech therapist, school psychologist,

(Valid as long as ancillary certificate remains

 

speech pathologist, or guidance counselor

valid)

Master’s degree*

 

 

At least six (6) semester hours in special education coursework

 

Three years of experience in certified area

Content Leader

Hold a valid type C, level 1 or higher Louisiana teaching certificate –or- have at least two

(Valid 5 years, renewable with effective

 

years of successful teaching if serving in a charter school

evaluations) *** No certification fee required

Successful completion of a BESE-approved content leader training program

 

Passing score on the Louisiana content leader assessment series

Dance Therapist (Bachelor’s)

Application signed & submitted by LA Employing School System

(Valid as long as individual remains in same

Official transcript showing the completion of a degree* in Dance Therapy

system)

Official transcripts showing the completion of two (2) semesters of a practicum completed in

 

 

both a clinical and school setting

 

Copy of registration by the American Dance Therapy Association

Dance Therapist (Master’s)

Application signed & submitted by LA Employing School System

(Valid as long as individual remains in same

Official transcripts showing the completion of a master’s degree* in Dance Therapy

system)

Copy of registration by the American Dance Therapy Association

Dyslexia Practitioner

Application signed & submitted by LA Employing School System

(Valid 5 years – renewable with effective

Hold a valid Louisiana teaching certificate

evaluations via Compass and valid credential)

Completion of an accredited multisensory structured language training programs (including

 

 

45 hours of coursework and 60 hours of clinical work observed/monitored by a qualified

 

 

professional) from one of the following:

 

 

The Academic Language Therapy Association (ALTA)

 

 

Academy of Orton-Gillingham Practitioners and Educators (AOGPE)

 

 

Wilson Language Training (WLT)

 

 

Neuhaus Education Center; and

 

Pass a multisensory structured language education-related competency examination

 

 

administered by a nationally recognized professional organization that issues national

 

 

certification

 

 

Valid credential from accrediting organization listed above

 

 

 

2

Dyslexia Therapist

Application signed & submitted by LA Employing School System

(Valid 5 years – renewable with effective

Hold a valid Louisiana teaching certificate

evaluations via Compass and valid credential)

Completion of an accredited multisensory structured language training programs (including

 

 

200 hours of coursework and 700 hours of clinical work observed/monitored by a qualified

 

 

professional) from one of the following:

 

 

 

The Academic Language Therapy Association (ALTA)

 

 

 

Academy of Orton-Gillingham Practitioners and Educators (AOGPE)

 

 

 

Wilson Language Training (WLT)

 

 

 

Neuhaus Education Center; and

 

Pass a multisensory structured language education-related competency examination

 

 

administered by a nationally recognized professional organization that issues national

 

 

certification

 

 

Valid credential from accrediting organization listed above.

Educational Diagnostician

Hold current national certification as an educational diagnostician

(Valid 5 years - renewable)

 

(NCED) through the National Certification Educational Diagnostician

 

 

Board.

 

 

Family & Consumer Science – Occupational

Application signed & submitted by LA Employing School System

Programs

Bachelor’s degree* in the family and consumer science specialty area

(Provisional valid 3 years, Qualified valid 5 years,

12 semester hours in professional education coursework

renewable with effective Compass evaluations)

 

2000 clock hours of successful work experience

 

For Qualified certificate, must have 3 years successful teaching on the Provisional

Junior ROTC

Application signed & submitted by LA Employing School System

(Valid 5 years –renewable with effective Compass

Documented retirement from active duty in the retired grades of E-6 through E-9, WO-1

evaluations)

 

through CWO-5, 03 through 06; and

 

 

 

Official Recommendation by appropriate branch of the military service with certification by the

 

 

appropriate Department of defense.

Math For Professionals

Application signed & submitted by LA Employing School System

(Valid initially 3 years and renewable every 5

Meets at least one of the following:

years with effective Compass evaluations)

 

a. Earned 30 credit hours of mathematics; or

 

 

b. Earned a Master’s Degree* in Mathematics, Engineering, Science Content Area; or

 

 

c. Successful passing of the Praxis Mathematics: Content Knowledge test #5161

 

Must have: Completion of a district developed classroom readiness/training program, based

 

 

on state guidelines.

Mental Health Counselor-Provisional

Application signed & submitted by LA Employing School System

(Valid 2 years, nonrenewable)

Hold a LPC, MFT, LCSW, certification as a School Psychologist, or current Louisiana licensure

 

 

as a psychologist.

 

 

Have two years of experience as a school psych, social worker, or mental health counselor

 

 

within the last five years.

Mental Health Counselor-Qualified

Application signed & submitted by LA Employing School System

(Valid as long as the individual holds valid license)

Hold a LPC, MFT, LCSW, certification as a School Psychologist, or current Louisiana licensure

 

 

as a psychologist.

 

 

Have two years of experience as a provisional mental health counselor.

Mentor Teacher

Hold a valid type C, level 1 or higher Louisiana teaching certificate –or- have at least two years

(Valid 5 years, renewable with effective

 

of successful teaching if serving in a charter school

evaluations) *** No certification fee required

Successful completion of a BESE-approved mentor teacher training program

 

Passing score on the Louisiana mentor teacher assessment series

Mentor Teacher (Provisional)

Hold a valid type C, level 1 or higher Louisiana teaching certificate –or- have at least two years

(Valid 1 year, nonrenewable)

 

of successful teaching if serving in a charter school

*** No certification fee required

Enrolled in a BESE-approved mentor training program

Music Therapist

Application signed & submitted by LA Employing School System

(Valid as long as individual remains in same

Official transcript showing the completion of a degree* in Music Therapy

system)

Copy of registration by the National Association of Music Therapy, Inc.

 

Verification of pre-clinical experience

Nonpublic Montessori

Diploma indicating the completion of an approved Montessori training program

(Valid 5 years – renewable with effective

 

 

 

 

evaluations)

 

 

 

 

Occupational Therapist-Certified Licensed

Copy of COTA License

Occupational Therapist Assistant (COTA)

Must work under a Licensed Occupational Therapist.

(Valid 5 years -renewable)

 

 

 

 

Occupational Therapist-Provisional

Copy of license to practice occupational therapy in Louisiana.

(Valid 2 years, nonrenewable)

 

 

 

 

Occupational Therapist- Full Certificate (Valid 5

Copy of Valid Louisiana Occupational Therapist License

years – renewable)

 

 

 

 

Orientation & Mobility

Bachelor’s or Master’s degree* in orientation and mobility; or

(Valid as long as holder maintains a current national

Completion of an individual plan of study in orientation and mobility; and

certification in orientation and mobility)

 

O

Current certification issued by the Academy for Certification of Vision Rehabilitation &

 

 

 

Educational

Professionals (COMS); or

 

 

O Current certification issued by the National Blindness Professional Certification Board

 

 

 

(NOMC).

 

 

 

 

 

 

 

 

 

 

3

Physical Therapist- Assistant

Copy of valid PTA License

(Valid 5 years – renewable)

Must work under the supervision of a licensed physical therapist.

Physical Therapist- Provisional

Copy of temporary Physical Therapist License

(Valid 2 years, nonrenewable)

 

 

Physical Therapist- Full Certificate

Copy of valid Physical Therapist License

(Valid 5 years – renewable)

 

 

School Guidance Counselor K-12

Completion of a standards based master’s degree* program in school counseling from a

(Valid 5 years - renewable)

 

college or university approved by the Council for Accreditation of Counseling and Related

 

 

Educational Program (CACREP)

 

Completion of a practicum in school counseling to include 100 contact hours in a school

 

 

setting –or- completion of an internship in school counseling to include 600 contact hours in a

 

 

school setting

 

Completion of the Praxis exam Professional School Counselor #0421 or 5421

School Librarian

Master’s degree* in library science

(Valid 5 years - renewable)

Passing score on Praxis Library Media Specialist (0311 or 5311)

School Nurse- Type C

Copy of current Louisiana registered nurse license

(Valid 3 years – renewable)

Verification of two years of service as a registered nurse (not as school nurse)

School Nurse – Type B

Copy of current Louisiana registered nurse license

(Valid 5 years – renewable)

Verification of three years of experience as a Type C school nurse.

School Nurse- Type A

Official transcripts of baccalaureate degree* in nursing or health related area

(Valid 5 years - renewable)

Completed Experience Verification Form verifying five years of service as a Type B School

 

 

Nurse

 

Copy of current Louisiana registered nurse license

School Psychologist- Provisional

Official transcript showing the completion of a bachelor’s degree*

(Valid 1 year, renewable once)

Letter from director of training program verifying completion of sixty (60) required semester

 

 

hours, with the exception of the internship

School Psychologist- Level B

Official transcript showing the completion of a master's or specialist degree* in School

(Valid 5 years - renewable)

 

Psychology, including an internship

School Psychologist- Level A

Official transcript showing the completion of a doctorate degree* in school psychology,

(Valid 5 years - renewable)

 

including an internship

School Psychology- Supervisor

Valid Type A or B school psychologist certificate

(Valid as long as certificate is valid)

Verification of three years of supervised experience as a school psychologist; two years must

 

 

have been in Louisiana

Social Worker- Provisional

Official transcripts indicating master's degree* in social work

(Valid 3 years, nonrenewable)

Copy of LMSW

 

Verification that applicant will work under Licensed Social Worker

Social Worker- Qualified

Official transcripts showing the completion of a master’s degree* in social work

(Valid as long as individual holds a current

Copy of LCSW or LMSW with verification of experience in a social worker setting

license)

 

 

Speech Pathologist Assistant

Official transcripts showing the minimum of a bachelor’s degree* in speech/language

(Valid 3 years; renewable)

 

pathology

 

Verification of 100 clock hours of supervised clinical practicum either in the form of licensure,

 

 

letter from program director, or a copy of a Louisiana provisional speech pathologist license

Speech Pathologist (Provisional)

Master’s degree* in speech pathology

(Valid 3 years; nonrenewable)

 

 

Speech Pathologist (Qualified)

Master’s degree* in speech pathology

(Valid as long as individual holds a current

Copy of current Louisiana licensure as a Speech Pathologist

license)

 

 

Speech Therapist/ASHA

Official transcripts showing master’s degree* in speech communication disorders

(Valid 3 years; renewable)

Copy of American Speech and Hearing Association (ASHA) license or letter from the director

 

 

of an ASHA approved training program verifying that all requirements have been met, with the

 

 

possible exception of the Clinical Fellowship Year (CFY) year

Talented (Music, Theatre, or Visual Arts)

Application signed & submitted by LA Employing School System or some type of verification

(Valid 5 years – renewable with effective

 

from system that applicant will be employed to teach specific art area

Compass evaluations)

Verification of a minimum of one year of working with students in the specific arts area at the

 

 

specific level.

 

Master’s degree* in Music, Art, Theatre, Liberal Arts, or Theatre Education

 

 

-OR-

 

Verification of substantial artistic or creative accomplishment over an extended period of time

 

 

(e.g., copies of newspaper articles, programs, brochures, playbills, published music,

 

 

magazine articles, catalogs, letters from peers) Photos, slides, and/or actual art work are not

 

 

acceptable.

*Degrees and coursework use for Louisiana certification purposes must be earned from a college or university accredited in accordance with 34 CFR 602.

4

ANCILLARY APPLICATION

Initial Ancillary Certificate

Social Security Number _____________________

Renewal of Ancillary Certificate

Date of Birth _________________________

Name of Applicant:_____________________________________________________________________

(Full Legal Name – First, Middle/Maiden, Last)

Check here if requesting a name change on the educator’s certification record (enclose copy of SSN card & driver’s license/ID).

Address: _____________________________________________________________________________

(Street)(City)(State) (Zip Code)

Phone: (_______)_________________________________________

Email Address:____________________________________________

Online Payment Confirmation # _______________________________ (Provide Email Receipt with Application)

Degree(s) Earned

EDUCATIONAL QUALIFICATIONS

Institution(s)

Date Degree(s) Earned

ANCILLARY CERTIFICATION

AREA REQUESTED:

(Select ONLY ONE from dropdown menu.)

I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this application.

Signature of Applicant: ________________________________________________________ Date: __________________

Louisiana Employing School System: _______________________________________________________________________

Signature of Employing School/School District: ______________________________________ Date: _______________

Rev. October 1, 2020 – pg. 5

PLEASE TYPE OR PRINT IN INK

PROFESSIONAL CONDUCT FORM

(All questions must be answered)

NAME OF APPLICANT: (Include First, Middle, Maiden, and Married)

Social Security Number:

 

______ - ______ -______

ADDRESS:

DATE OF BIRTH:

 

 

Each Question must be answered:

Please Check

YES NO

1.Have you ever had any professional license/certificate denied, suspended, revoked, or voluntarily surrendered?

If YES, in which state?____________________________

2.Are you currently being reviewed or investigated for purposes of such action as stated in #1 or is such action pending?

If YES, in which state?_____________________________

3.Have you ever been convicted of any felony offense, been found guilty or entered a plea of nolo contendere (no contest), even if adjudication was withheld?

If yes, please provide the following information:

Date of Conviction: ____________________

State of Conviction: _____ Court Jurisdiction of Conviction: __________________

4.Have you ever been convicted of a misdemeanor offense that involves any of the following:

a.Sexual or physical abuse of a minor child or other illegal conduct with a minor child.

b.The possession, use, or distribution of any illegal drug as defined by Louisiana or federal law.

5.Have you ever been granted a pardon or expungement* for any offense as stated in #3 or #4?

NOTICE---EXPUNGEMENTS, FIRST OFFENDER PARDONS, PRE-TRIAL DIVERSIONS: Criminal Background Checks (CBCs) conducted for purposes of employment will be conducted in accordance with La. R.S. 17:15 and La. R.S. 15:587.1. Pursuant to Louisiana law R.S. 15:587.1., background checks shall

disclose ALL ARRESTS, COURT ACTION and CONVICTIONS, (Including but not limited to expungements, first offender pardons and pre-trial diversion), and a copy of the report shall be provided to the Louisiana Department of Education (LDE), in addition to the potential employer or LA Education Agency (LEAs)s.

*Per BESE policy set forth in Bulletin 746, LOUISIANA STANDARDS FOR STATE CERTIFICATION OF SCHOOL PERSONNEL, Section 903.C, failure to disclose actions such as first offender pardons, pre‐trial diversion, expungements, etc. is grounds for certification denial and/or revocation.”

If you answered “YES” to any questions, #1 through #5, you must provide court certified copies of all documents and proceedings, civil records of Federal, State and/or District School Board actions, or other relevant documents that provide full disclosure of the nature and circumstances of EACH separate incident in your application packet.

I affirm and declare that all information given by me in the responses to items #1 through #5 above is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation of facts, by omission or addition, may result in criminal prosecution and/or the denial or revocation of my teacher certificate. I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this document.

SIGNATURE OF APPLICANT:

DATE:

EXPERIENCE VERIFICATION FORM

PLEASE TYPE OR PRINT IN INK

Louisiana Certificate Type/Number: __________ Social Security Number: ________ - _____ - ________

Name: ____________________________________________________ Date of Birth: ____/____/____

 

 

 

(First)

(Middle)

 

 

 

(Last)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address: __________________________________________

Phone #: (_____) _________________

 

 

 

 

(Street)

(City/State)

 

 

 

(Zip Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COUNTRY/

 

 

 

 

 

 

Type of School

 

Grade

 

 

Subject(s)

 

 

School

 

 

Position

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PARISH/

 

 

NAME OF SCHOOL

 

 

Public

 

 

Private

 

 

Level(s)

 

 

Taught or

 

 

Year(s)

 

 

(teacher,

 

 

 

 

DISTRICT/

 

 

 

 

 

 

 

 

 

 

Taught/

 

 

Service

 

 

Taught/

 

 

 

 

 

 

 

 

 

 

 

 

School

 

 

School

 

 

 

 

 

 

 

 

nurse, etc.)

 

 

 

 

COUNTY

 

 

 

 

 

 

 

 

 

Provided

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Served

 

 

 

 

Served

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Ex. 2012-2013,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

I agree that my electronic signature as entered below is the legal equivalent of my manual signature on this application.

ORIGINAL SIGNATURE OF APPLICANT:

DATE:

ORIGINAL SIGNATURE OF EMPLOYING AUTHORITY:

DATE:

 

 

TITLE & DISTRICT OF EMPLOYING AUTHORITY:

EMAIL:

 

 

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1. Whenever completing the ancillary certification online, ensure to incorporate all of the necessary fields in their associated section. It will help to facilitate the work, which allows your information to be processed without delay and accurately.

The best way to complete louisiana ancillary certification step 1

2. Once the previous array of fields is finished, you'll want to include the needed particulars in Initial Ancillary Certificate, Renewal of Ancillary Certificate, Social Security Number , Date of Birth , Name of Applicant, Full Legal Name First, Check here if requesting a name, Address , Street, City, State, Zip Code, Phone , Email Address, and Online Payment Confirmation so you can move on further.

Part # 2 of filling out louisiana ancillary certification

It's very easy to get it wrong while completing the Renewal of Ancillary Certificate, thus be sure you look again before you decide to finalize the form.

3. This next part is focused on Degrees Earned, Institutions, Date Degrees Earned, ANCILLARY CERTIFICATION AREA, I agree that my electronic, Signature of Applicant Date , and Louisiana Employing School System - fill in every one of these empty form fields.

Step # 3 of completing louisiana ancillary certification

4. This next section requires some additional information. Ensure you complete all the necessary fields - NAME OF APPLICANT Include First, ADDRESS, Social Security Number DATE OF, Each Question must be answered, Please Check YES NO, Have you ever had any, or voluntarily surrendered If YES, Are you currently being reviewed, stated in or is such action, Have you ever been convicted of, plea of nolo contendere no contest, If yes please provide the, Date of Conviction , State of Conviction Court, and Have you ever been convicted of a - to proceed further in your process!

Completing section 4 in louisiana ancillary certification

5. When you reach the conclusion of your form, you'll notice a couple extra things to do. Particularly, b The possession use or, or federal law, Have you ever been granted a, NOTICEEXPUNGEMENTS FIRST OFFENDER, Per BESE policy set forth in, If you answered YES to any, I affirm and declare that all, and DATE must be filled out.

Per BESE policy set forth in, If you answered YES to any, and DATE of louisiana ancillary certification

Step 3: Prior to getting to the next stage, ensure that all blanks are filled out the correct way. Once you determine that it's correct, click on “Done." Sign up with us now and easily get ancillary certification online, all set for download. All modifications you make are preserved , enabling you to customize the file at a later stage when necessary. When using FormsPal, it is simple to fill out documents without worrying about information leaks or entries being distributed. Our protected platform helps to ensure that your personal data is maintained safe.