Form Spi Cert 1522F – Fill Out and Use This PDF

NBPTS CERTIFICATION QUALIFYING FOR WASHINGTON ENDORSEMENT

AND EXEMPT FROM WEST-E REQUIREMENT

ADDITIONAL ENDORSEMENT APPLICATION CHECKLIST

FORM SPI/CERT 1522A APPLICATION FOR AN ENDORSEMENT

Submit FORM SPI/CERT 1522E, Institutional Verification of Program Completion and Character

OR

Copy of valid National Board for Professional Teaching Standards (NBPTS) certificate

OR

Submit FORM SPI/CERT 1522F, Verification of Endorsement Experience and photocopy of WEST-E score report

Washington Certificate - Submit original teaching certificate so that it can be reissued with the added endorsement. The reissued certificate will bear the same dates as the original certificate. Adding an endorsement does not affect the validity of your certificate.

Additional Endorsement requested: $15 (per endorsement) + $33 (OSPI) per endorsement = $48

SEND YOUR COMPLETE APPLICATION PACKET AND FEE TO OSPI, FISCAL OFFICE, P.O. BOX 47200, OLYMPIA, WA 98504-7200.

I am enclosing a COMPLETE Washington teacher certification application.

1522 Chklst (Rev. 9/14)

OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION

Professional Certification

OLD CAPITOL BUILDING, PO BOX 47200

OLYMPIA WA 98504-7200

(360) 725-6400 TTY (360) 664-3631

Web Site: http:/ /www.k12.wa.us/certification/

E-Mail: cert@k12.wa.us

APPLICATION FOR AN ENDORSEMENT

Note: This application is for those who hold a valid Washington teaching certificate and want to add an endorsement based on completion of another state’s state-approved program, a valid National Board certificate, or passing an approved WEST-E assessment and appropriate experience in a Pathway 1 area compatible with an endorsement already held. If you have completed an endorsement program or Pathway 2 pedagogy assessment at a Washington Professional Educator Standards Board-approved college/university, contact your college/university for instructions.

Please complete the following and sign the affidavit.

Endorsement(s) requested and corresponding WEST-E test completed:

AFFIDAVIT

I, _________________________________, certify (or declare) under penalty of perjury under the laws of the State of

Washington that the foregoing and all information included in this application is true and correct. If the answers to any question on the application or the character and fitness supplement on the application change prior to my being granted certification, I must immediately notify Professional Certification at OSPI.

THIS FORM MUST BE INCLUDED IN THE APPLICATION PACKET. ATTACH YOUR CHECK TO THIS FORM.

DO NOT WRITE IN THIS SPACE BELOW

For Professional Certification Use Only

Complete Section A of this form. Send it to the education department of the college/university where you completed your endorsement program. This form, when returned to you, is to be included with your application packet.

SECTION A

TO BE COMPLETED BY APPLICANT

SECTION B

TO BE COMPLETED BY COLLEGE/UNIVERSITY

The above named is an applicant for endorsement in Washington State. Complete information in Section B. To be valid, this form must be signed by the dean of the college or school of education, the certification officer, the chair of the education department, or the dean’s designee at the institution where the applicant completed his/her endorsement program. A stamped signature must be initialed by the person using the stamp. RETURN THIS FORM TO THE APPLICANT.

If no, what were the deficiencies?

For C & D, please note: In order to qualify for an endorsement area, the applicant must have completed an approved program in that area. Each endorsement program must include coursework in methodology for that content area and completion of a field experience/internship that includes instruction in that content area.

C.Area in which applicant is recommended for certification. Please indicate area and grade level(s).

D.Other approved content area/endorsement programs that applicant has completed:

E.Do you have knowledge that the applicant has been arrested, charged, or convicted of any crime or has a history of any serious behavioral problems?

()

Endorsement Requirements

State-Approved Program. Candidates from out of state must provide verification that they completed a state- approved college/university program (equivalent to a major) in an endorsement area.

Methods Course(s). For endorsements, teachers must have completed related methods coursework in the specific endorsement area(s).

Field Experience/Internship. For endorsements, teachers must have completed a supervised practicum which included teaching in the specific endorsement area(s).

Specialty Areas. Specialty areas were created to help teachers specialize beyond the required certificate endorsements and have unique competencies not found in regular endorsements. Specialty areas cannot stand alone on a certificate; they must be in addition to a regular endorsement.

USE THIS FORM IF YOU ARE APPLYING FOR AN ENDORSEMENT VIA TESTING

SECTION I

TO BE COMPLETED BY APPLICANT

Applicants will need to meet the experience requirement listed below to add an endorsement via testing:

Verification of 90 days of teaching experience in the endorsement that is compatible in instructional methodology and content-related skills to the desired endorsement. If verifying experience for more than one employer, photocopy this form and send a copy to each employer.

TO BE COMPLETED BY EMPLOYER, OR HIS/HER DESIGNEE, WHERE APPLICANT WAS EMPLOYED

Based on personnel records, this statement MUST be prepared and signed by the superintendent or the personnel director of the school district, or private school, where the applicant was employed. Stamped signatures MUST be initialed by the individual using the stamp. Please return this completed form directly to the applicant.

RETURN COMPLETED FORM TO APPLICANT

FORM SPI/CERT 1522F (Rev. 2/12)