To fill out an ancillary certification form online, you do not need to download any software. FormsPal's PDF editor works directly in your browser. Follow these steps to complete your ancillary application form.

Step 1: Click the "Get Form" button above. This opens the PDF editor so you can begin entering your information.

Step 2: The document will appear on screen, ready for input. In addition to filling in fields, you can add custom text, edit existing content, insert images, and add your signature.

Fill out every field with care. Accuracy in your ancillary application helps avoid delays in the review process.

1. Start with the personal and certification information section. Complete all required fields, including your certificate type selection, to ensure your ancillary certification application is processed without delay.

How to complete the ancillary application form step 1

2. In the next section, enter your personal details. Fill in fields for Initial Ancillary Certificate or Renewal of Ancillary Certificate, Social Security Number, Date of Birth, Full Legal Name, mailing address, phone number, email address, and Online Payment Confirmation.

Filling out part 2 of the ancillary application form

Double-check the Renewal of Ancillary Certificate fields before proceeding. This section is a common source of errors.

3. Complete the education and field section. Enter your Degrees Earned, Institutions attended, Dates of Degrees Earned, and your selected Ancillary Certification Area. Include your electronic signature and the name of your Louisiana Employing School System.

Completing the education section of the ancillary application

4. The conduct disclosure section requires answers to all background questions. Complete each field: NAME OF APPLICANT, ADDRESS, Social Security Number, DATE, and respond Yes or No to each conduct question. Include required details for any Yes answers.

Completing the conduct section of the ancillary certification form

5. At the end of the ancillary application, complete the final affirmation section. Include all required declarations, policy acknowledgments, and your signature with the date.

Final section of the Louisiana ancillary application form

Step 3: Review all fields once more before finalizing. Click "Done" when the form is complete. You can create a free FormsPal account to save your progress and return to edit the form later. Your data stays protected with our secure platform.

Common questions about the ancillary application form

What fields does the ancillary application require? The form requires personal identification, your selected certification area, educational background, professional conduct disclosures, and a signed affirmation.

Can I renew my ancillary certificate using this form? Yes. The form includes a section for Renewal of Ancillary Certificate. Select the renewal option at the top of the form before completing the remaining fields.

Where do I submit the completed ancillary application? Submit your packet through the Louisiana online educator certification portal. Attach all required supporting documents, including official transcripts and any required licensure copies.

Related forms you may need: ANCC certification verification form.

Question	Answer
Form Name	Ancillary Application Form
Form Length	7 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 45 sec
Other names	ancillary certification packet, louisiana ancillary certification, louisiana ancillary certification application, ancillary certificate

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,
(Provisional valid 3 years, Qualified valid 5 years,	•	12 semester hours in professional education coursework
renewable with effective Compass evaluations)	•	12 semester hours in professional education coursework
	• 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)
evaluations)		through CWO-5, 03 through 06; and
		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.

Ancillary Application Form – Fill Out and Use This PDF

Ancillary Application Form PDF Details

Required documents for the ancillary application packet

Processing fees and exemptions

How to submit your application

Form Preview Example

How to Edit Ancillary Application Form Online for Free

Common questions about the ancillary application form

Ancillary Application Form isn’t the one you’re looking for?

Ancillary Application Form – Fill Out and Use This PDF

Ancillary Application Form PDF Details

Required documents for the ancillary application packet

Processing fees and exemptions

How to submit your application

Form Preview Example

How to Edit Ancillary Application Form Online for Free

Common questions about the ancillary application form

Ancillary Application Form isn’t the one you’re looking for?

Related Documents