Ga Psc Experience Verification Form PDF Details

The Georgia Professional Standards Commission's (PSC) Experience Verification Form, revised in March 2012, serves a critical role in the certification process for educational professionals in Georgia. Situated at 200 Piedmont Avenue, Suite 1702, Atlanta, GA 30334-9032, this form requires the use of black ink or typewriting, with all details provided in capital letters. It is designed for individuals seeking certification as Teacher Support Specialists, educators with full-time teaching experience in PSC-accepted accredited colleges within the last five years, those with out-of-state school experience wishing to bypass certain Georgia-specific requirements, or individuals aiming to meet recency requirements through at least one year of full-time certified school experience outside Georgia in the past five years. The form also details the employer section, which must be completed by a current or previous employer with authority, such as a Superintendent, Headmaster, Agency Director, or Designated Personnel Officer—it explicitly states that Principals can only sign the form if they are the designated personnel officers. The documentation process includes verifying full-time or consecutive years of half-time educational employment, specifically excluding leave of absence periods. It further breaks down the verification to include specifics such as dates of service, performance ratings, grades and subjects taught, major portion of the school day activities, and the type of accreditation held by the institution, ensuring a thorough assessment of an applicant's professional background. Finally, it requires identification of any special education roles filled, underscoring the detailed nature of the verification process designed to ensure candidates meet the stringent standards set forth by the Georgia PSC.

QuestionAnswer
Form NameGa Psc Experience Verification Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namespsc experience verification form, gapsc experience verification form, georgia psc experience verification form 2015 fillable, georgia psc experience verification form revised may 2015

Form Preview Example

Georgia PSC Experience Verification Form – Revised March 2012

200 Piedmont Avenue, Suite 1702, Atlanta, GA 30334-9032

Please Use Black Ink or Type

Please use ALL CAPS and print your name as you wish it to appear on your certificate

Title

Last name

Mr

Ms

Dr

First name

Social Security Number

-

 

 

-

Middle or Maiden Name

Date of Birth (MM/DD/YY)

/

 

 

/

The Experience Verification Form is used to verify educational work experience. You must submit this form if:

(a)you are requesting certification for Teacher Support Specialist;

(b)you have taught full time in a PSC-accepted accredited college during the last five years;

(c)you are using out of state school experience (3 satisfactory years within the last 5 years) in lieu of a GACE Content Assessment and/or other special Georgia requirements;

(d)you have a minimum of one year in the past five of full-time certified school experience out-of state to meet recency.

Employer Section:

The information listed below is to be completed by the current or previous employer (Superintendent, Headmaster, Agency Director, or Designated Personnel Officer). Principals are not authorized to sign this form unless they are the designated personnel officer. Please note that if verifying college experience, only full-time college experience can be accepted. (One year of full-time teaching experience at a college or university is defined as teaching 9 semester hours each semester for two consecutive semesters.) Use one line for each change in status. Do not include leave of absence periods. Please verify only full-time or consecutive years of half-time educational employment experience.

∙

∙

 

 

Regional

 

 

 

 

 

 

 

Or State

Dates of Service

Ratings on

Grades & Subjects

Certificate

School District

 

Accreditation?

From

To

Performance

Taught Major Portion

Held?

Or Institution

State

(Specify

Reviews

of School Day*

 

mm/dd/yy

mm/dd/yy

Yes/No

 

 

Agency)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfactory

 

 

 

 

 

 

 

Unsatisfactory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfactory

 

 

 

 

 

 

 

Unsatisfactory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfactory

 

 

 

 

 

 

 

Unsatisfactory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfactory

 

 

 

 

 

 

 

Unsatisfactory

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Satisfactory

 

 

 

 

 

 

 

Unsatisfactory

 

 

 

 

 

 

 

 

 

 

If Special Education was taught, please identify the disability served (e.g. BD, LD, MR, cross-categorical, etc.)

If Middle Grades or Special Education was taught, please identify the specific academic subject area(s)

Name of Authorized Official (Please print or type)

 

 

Signature of Authorized Official

Date

 

 

 

 

 

Title

 

 

School System, Agency, Private Institution

 

 

 

 

 

 

Phone number

Email address

 

City, State, Zip

 

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2. Once your current task is complete, take the next step – fill out all of these fields - Specify Agency, mmddyy, mmddyy, YesNo, Satisfactory, Unsatisfactory, Satisfactory, Unsatisfactory, Satisfactory, Unsatisfactory, Satisfactory, Unsatisfactory, Satisfactory, Unsatisfactory, and If Special Education was taught with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

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