INSTRUCTIONS FOR COMPLETING APPLICATION - · PDF fileinstructions for completing application...

PDE Bureau of School Leadership and Teacher Quality

UCPS_WebsiteDocumentsCertification Application UPDATED 2010 1012 (2)docx

INSTRUCTIONS FOR COMPLETING

APPLICATION FOR PENNSYLVANIA CERTIFICATE FOR

TEACHER (INSTRUCTIONAL LEVEL I) SUPERVISOR EDUCATIONAL SPECIALIST OR PRINCIPAL

1 Take and pass the PRAXIS test before applying for certification Your faculty advisor can guide you on which PRAXIS tests to take IMPORTANT When registering to take Praxis tests

be sure to specify Bloomsburg University ndash code (2646) as a score recipient BU is listed

twice with ETSmdashbe sure to specify 2646 IF YOU REGISTER ONLINE no report is mailed to you

so be sure to view AND print your scores online within the specified period

2 Complete Form PDE 338-G Read all instructions ndash the entire application ndash before starting Regarding Section II-2 Only one subject area can be requested If you completed more

than one certification major at BU it will be listed on 338C by Bloomsburg University

AT YOUR REQUEST See sample on the last page

Regarding Section III Your physician must complete this section if you are applying

for your first Pennsylvania certificate It needs to be your doctorrsquos original

signature with MD or DO number (signatures NOT accepted nurse physicianrsquos assistant

a stamp or anyone on behalf of your physician) This signature is valid for one year

3 Complete Form PDE 338-C Page 1 Section I only ie just your name and social security number Page 2 Applicant name and SSN at the top of the page

4 PDE 338-V form is needed only for those applying for a graduate-level supervisory certificate or administrative principal certificate (not an Instructional Level I)

5 Attach a US money order in the amount of $100 payable to the Commonwealth of Pennsylvania We CANNOT accept personal checks or credit cards for certification

6 Send The completed application (Forms PDE 338G and 338C) with original signatures

If your scores were not sent to BU attach a copy of your PRAXIS scores

$100 US money order payable to Commonwealth of Pennsylvania

Send to Teacher Certification Coordinator

Bloomsburg University of Pennsylvania

400 E 2nd Street MCHS 3105

Bloomsburg PA 17815

NOTE Your bachelors degree must be granted all BU ldquoholdsrdquo satisfied before your

application can be sent from BU to PDE

To contact Bloomsburg Universityrsquos Teacher Certification Coordinator

570-389-5128 or FAX 570-389-5049

To ask about PRAXIS test dates BU 570-389-4112 or PRAXISETS 609-771-7395 or wwwetsorgpraxis

To inquire about which tests to take contact your faculty advisor andor wwwetsorgpraxis

―State Testing Requirements ―Pennsylvania State Requirements ―How to Qualify for

Certification

To contact the Pennsylvania Department of Education (PDE) Customer Service (717) 787-3356

After graduation or after applying to check the status of your certificate after BU sends it to

PDE or to check PRAXIS test requirements after you graduate (eg to add certificates after your

first one) wwwteachingstatepaus ―Access Services for certificate status or ―Testing

Requirements NOTE you must get your first certificate through BU sponsorship before you can

pursue add ons

BU office hours are 730 AM-400 PM Monday through Friday

Summer BU hours are 730 AM ndash 400 PM

PDE Bureau of School Leadership and Teacher Quality Page 2


NOTE These instructions and forms also can be printed from

wwwbloomueduformsPACertificationApplicationpdf

Bloomsburg Universityrsquos Checklist

Have you

Included a United States money order for $100 payable to Commonwealth of

Pennsylvania

Included form ―General Application Form PDE 338G

Obtain original signature of your physician if this is your first

PA certificate

OR

If this is your second certificate the physician signature is not

needed again however please attach a copy of your first

certificate

Included form ―CollegeUniversity Verification Form PDE 338C

If you are applying for principal or a supervisory certificate included

PDE Form 338V ―Verification of Experience for each employer

For some applicants If you did not specify BU code 2646 to get your

PRAXIS scores or if you are unsure have you included a photocopy of all

pages of your PRAXIS score report

Optional If you have not yet taken or have not passed all of your

tests list below the test date when you will complete them

Optional If you need a ―Temporary Substitute Teaching Letter have you

checked this box and returned this page with your application This

letter can be done only after all requirements are finished It can be

mailed to you the same day Bloomsburg University sends your certification

application to the Pennsylvania Department of Education

Optional Have you enclosed a self-addressed stamped envelope to

receive a temporary substitute teaching letter and a confirmation note

showing the date on which your application was sent from Bloomsburg

University to the Pennsylvania Department of Education

NOTE Applications submitted to Bloomsburg University near one of the commencements

(December May August) may take longer to be processed Expect three weeks at

Bloomsburg after grades are posted and degrees are granted and everything is complete

and approximately eight weeks for processing at PDE Except if you noted above that

you are awaiting test scores or except for anticipated graduation at the end of this

semestersummer you will be notified by phone or mail if your application is missing

something Otherwise confirmation will be sent to you the same day the application

is mailed to PDE Incomplete applications will be held six months then returned to

you

COLLEGEIUNIVERSITY VERIFICATION FORM PDE 338 C Completion of Approved Education Program

For Use by Applicants Prepared by PA CollegesUniversities (Refer to instructions included with this form)

APPLICANTS Please note the following Information in regard to your Social Security Num ber (SSN) DATA REQUIRED BY THE FEDERAL PRIVACY ACT (5 USC Section 552a note) AUTHORITY 24 PS Section 1224 PURPOSE(S) To be used for ( I) registration and maintenance of records of all certifica ted persons as hav ing met qual ifications for teaching (2) identification and collection of criminalldiscipl inary records for certi fied educators and candidates for certification and (3) provision of certification data to authorized personnel and agencies DISCLOSURE Failure to disclose will further of the

1 certify that the applicant has achieved at least a sati sfactory rating on the PDE 430 PA Statewide Evaluation Form for Student Professional Knowledge and Practice

2 Check and Init ial one of the following statements

o

o

o

[certify that the applicant has been formally admitted to and is pursuing an approved intern program to qualify for a certificate in the Subject Area(s) or Field(s) listed below

I certify that the applicant has completed an approved program (PA Code sect4968) and has successfully demonstrated competencies to qualify for a certificate in the Subject Area(s) or Field(s) listed below Date of program completion____________ _

I certify that the applicant has completed an approved program (PA Code sect 4968) but the preparing institution is not recommending the candidate for certification A letter of explanation is enclosed with the POE 338 C form

3 Check the box and initial one of the following statements

4

o The applicant has earned an overall 30 GPA or higher and has met the qualifying assessment score

o The applicant has below a 30 GPA but has a least an overall 28 GPA and has scored one standard deviation above the qualifying score on the appropriate content area assessment

o The applicant has met the qualifying assessment score(s) based upon an overall GPA of 31-40 The applicants overall GPA is _ ______

Subject Area or Field Type Code Area Code


Date of initial conferred Bachelors Degree

Initial

Initial

Initial

Initial

Initial

Page 1 of3 PDE 338C (Revised 61 0)

Applicant Name_ ___ _ _ ___________ SSN_____________________

5 To the best of my knowledge and belief the candidate is known and regarded by the preparing institution as a person of good moral character and possesses those personal qual ities and professional knowledge and skill which warrant issuance of the requested certificate (If the certification officer possesses information which prevents verification of the good moral character of the candidate a Initial statement of explanation must be attached to the 338 C form)

SECTION III-CERTIFICATION OFFICIAL INFORMATION

Name of College or University College Code Number

Name of Certifying Official Title

Signature of Certifying Official Date

SECTION IV-OFFICIAL TEST SCORES Attach the test score label(s) in the space provided

Page 2 of3 PDE 338C (Revised 61l 0)

INSTRUCTIONS FOR COLLEGEUNIVERSITY VERIFICATION FORM PDE 338 C

SECTION I Applicant In fo rmation

1 Print or type your Last Name First Name Middle Initial and enter your Social Security Number

2 Send this form to your collegeuniversity certification office

SECTION II Preparing coJlegelUniversity Recommendation

1 If the cand idate has achieved at least a satisfactory rati ng on the final PDE 430 confirm by printing your initials in the box

2 Check the box indicating what type of program the candidate has completed and enter the date of program completion ifapplicable Confirm by printing your initials in the box provided If the candidate has completed the program in full but the institution is not recommending the candidate for PA certification a letter of explanation must be enclosed

3 Check the appropriate box to indicate the GPA-assessment method the candidate has met in order to be recommended If the Qualifying Score-GPA method was utilized for recommendation purposes indicate the candidates overall GPA as listed on the institutions official transcripts

4 Print the certification Subject Area(s) or Field(s) and Code numbers you are recommending

NOTE If a collegeuniversity is recommending more than one area of certification

(a) When the student completes Form PDE 338 G item 9 heshe should enter only one Subject Area and Area Code Any area being sought may be selected

(b) On the PDE 338 C form the collegeuniversity must list ALL the Subject Areas and Codes for which the student is being recommended

Print the date of the initial conferred Bachelors degree

5 Please initial the box provided to indicate that the institution is currently unaware of any information that the educator does not possess good moral character If the institution is aware of information which prevents attestation of the good moral character of the candidate a letter of explanation must be included with the PDE 338 C form

SECTION III Certifying Official Information

J Enter the Name of CollegeUniversity College Code Number and your Name and Title

2 Sign and date the application

SECTION IV Official Test Scores

Apply the appropriate test score label(s) (with the passing scores) in the space provided

Send the PDE 338 C fo rm PDE 338 G form and fee to the Pennsylvania Department of Education

Page 3 of3 POE 338C (Revised 6110)

---

---

PDE USE ONLY

GENERAL APPLICATION FOR PENNSYLVANIA CERTIFICATE FORM PDE 338 G

(Refer to instructions included with this two page form) CONTROL NO

APPLICANTS Please note the following Information In regard to your Social Secur ilY Number (SSN) DATA REQUIRED BY TH E FEDERAL PRIVAC Y ACT (5 U SC Sec tion 552a note) AUTHORITY 24 PS Section 1224 PURPOSE(S) To be used for (I) registration and ma intenance of records oral l cert ifi cated persons as having mel qualifications for teaching (2 ) identification and collection of cri m mald iscipl inar) records fo r ceni tied educato rs and cand idates fo r cen l tical ion and (J) prov ision of ceni ficati on data to authorized personnel and agencies DISCLOSURE Mandatory Fa ilure to disclose wi ll preven t funher processing of the applica tion

SECTION I - PERSONAL INFORMATION (please print or type) I Last Name First Name Middle Initial

3 Address

CityStateZip Code

6 Telephone

HomeCe ll ( ) Work Phone ( )

8 Please list all fonner nam e(s) beginning with the most recent

Last First MI

SECTION II-CERTIFICATION INFORMATION

2 Soc ial Security Number

4 Date of Birth (mmddyyyy)

5 o Male o Female

7 E-Mail Address

9 Are you a United States Citizen)

0 Yes

0 No

1 Date Initial Bachelor s Degree conferred (Do not li s t M as ters or Doctorate leve l degree-only Baccalaureate degree)

MonthlYear Degree Co llegeU niversity

2 Subject Area and 4-digit Code of the certification area for which you a re applying (enter the area of co ncentration or endorsement if applicable)

SECTION III

ubject Area 4-digit Code

-HEALTH CERTIFICATE The Health Certificate section must be completed by a

Concentration(s) Endorsement

ni ted S tates licensed physician

[ certify that I am a physician lega lly qualified to practice medicine in a state of the United States or its capital that I have examined and find the above named applicant able to perform the essential functions and duties of a teacher with or without reasonable accommodation The applicant does not because of tuberculosis or any other commun icable d isease or mental di sab ility pose a direct threat to th e health or safety of others that cannot be eliminated by a reaso nable accommodation

Signature of Examining Physician

LJ_ Date

_ _ _ _ State in which licensed State License No Daytime Phone Number

POE 33 8 G (Revised 710)

Page I of 5

I

Read and answer each question cilrefu~v ensurc that you have selected the appropriate check box Incorrectly checking a box may signi licantly delay the processing of you r application Please refer to the instruction sheet for further information

l Have yo u ever been the subject ofa child abuse in ves ti gatio n or report in this or any other state territory or country) (If yes indicate whether the investigation or report is indicated unfounded or founded by checking the appropriate box)

2 Are you currently the subject of any misconduct investi gation by an employer (If yes refer to instructions)

3 Have you ever resigned from or otherwise left any employment (eg settlement agreement) while allegations of misconduct were pend i ng or under investigation ) (If yes refer to instructions)

4 Is there disciplinary action pending by a licensing agency in this or any other state territory or country (If yes refer to in structions)

5 Have yo u ever had any certificate or license for any profession denied revoked suspended surrendered or received a public reprimand in this or any other state territory or country (If yes refer to instructions)

6 Have you ever been convicted of a crime classified as a misdemeanor or felony in this state or any other state territory or country (If yes refer to instructions) (For purposes ofthis question convicted includes pleas ofnolo con fendre and guilty pleas However summary offenses do not need 10 be acknowledged)

7 Are criminal charges pending against you or are you the subject of an inquiry or investigation by a law enforcement agency in this or any other state territory or country) (If yes refer to instructions)

0 Unfounded 0 Indicated 0 Founded 0 No

C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No

The Pennsylvania code of Professional Practice and Conduct for Educators which may be found on the PDE website sets forth the standards for professional practice for Pennsyl van ia professional educators All professional educators are expected to conduct themse lves in accordance with the Code Failure to do so may resul t in professional di sci pline Indicate that you have read the code by checking the box below

o I certify that [ have read and will abide by the Code of Professional Practice and Conduct for Educators

SECTION VI-AFFIDAVIT

1 certify that the information provided in this application including all statements transcripts and documentation are correct and true 1 understand that the falsification ofany statement or document may result in professional discipline including revocation ofmy Pennsylvania certificate

Signature of Applicant Date

PDE 338 G (Revised 711 0)

Page 2 of 5

INSTRUCTIONS FOR GENERAL APPLfCATION - FORM PDE 338 G PRINT W ITI-I DARK BLUE OR BLAC K INK

SECTION I Persona l In formation

I Print your Last Name First Name and Middle Initial 2 Print your Social Security Number 3 Print your complete Address and Zip Code 4 Print your Date of Birth 5 Check the appropriate box for male or female 6 Print your telephone numbers in the event you must be contacted 7 Print your current e-mail address 8 Print your former names if applicable 9 Please state your citizenship status by checking the yes or no box rf you are not a US citizen you

must enclose the following documents with your application

bull A copy of the front and back of your permanent resident visa which permits you to permanently reside and work in the United States

bull A Decoration of Intent to Become a Citizen ofthe United Slates form This form is included in the Foreign Supplement Package available from the POE website at vdul3tionst3tepa us This does not apply to Foreign Language teachers

bull If you have become a citizen since submitting your last application you must return your original Alien Provisional Certificate as well as a copy of your US Naturalization Paper for conversion

H the documentation noted above is not submitted with the POE 338 G form the application will be returned to you

SECTION II Certification Information

Enter the MonthlY ear name of degree and college from which you received your initial bachelor s degree Do not list information regarding Masters or Doctorate degrees

2 List the Subject Area for which you are applying and specify the Code Select a Subject Area and Code from the Subject Areas and Codes list

3 Ifapplicable enter the area of concentration (mid-level certificates) or the endorsement (example ESL)

SECTI O N JlI Health Certificate

A US licensed physician must sign the Health Certificate section of this application POE will not accept a nurse or physicians assistant signature The Health Certificate section is not required if the applicant holds or has held a PA certificate including Emergency Permits or Temporary Teaching Permits

SECTION IV Baclltground

Please note Incorrectly answering the questions in this section may signifi ca ntly delay the processing of your application

1 I f you have answered unfounded founded or indicated you must provide a current original Chi Id Abuse Clearance from the state territory or country in which the investigation or report occurred and a signed letter of explanation with your application I f you have never been the subject of a child abuse investigation or report select the no box

2 I f you have answered yes a signed letter of explanation as well as any public documentation pertaining to the di sciplinary action must be submitted with this application

3 If you have answered yes a signed letter of explanation as well as any documentation pertaining to the disciplinary action termination investigation or resignation must be submitted with this application

Page 3 of 5

4 If you have answered yes a signed letter of explanation as well as any public documentation pertaining to the di sciplinary action must be submitted with this application

5 If you have answered yes you will not be automatically prevented from obtaining a PA certificate A certificatio n denial based on insufficient credentials (such as lack of coursework or test scores) does not need to be acknowledged Any documentation pertaining to the denial revocation sus pension surrender or reprimand must be submitted with this application

6 I f you have answered yes please include the following in your application (A YES answer does not automatically prevent an applicant from obtaining a PA certificate)

bull a signed letter of explanation

bull your resume bull certified court documents related to all criminal matters bull a current original FBI Clearance or regi s tration identification number bull a current orig inal PA Criminal Background Check bull a current original PA Child Abuse Clearance bull a letter from your probation officer if appl icable and bull five letters of reference from individuals who have direct knowledge related to the conduct that led

to the charges or conviction [fyou are currentl y employed by a school district letters of reference from the employer or supervisor are recommended

7 [fyou have answered yes please attach the additional documentation as listed above

SECTION V Code of Conduc t

The Pennsylvanias Code of Professional Practice and Conduct for Educators may be found a t httpwwwlx n a lslate() uspo rtalserHmiddotrPlcomrnu ih lidd inesoo2C polic ies2 com plaint forms))C repor lS and re lated cto(umelw l l 50 code -It wndud29193 Review the code and check the box indicating that you have read and will abide by the Pennsy lvania s Code of Profess ional Practice and Conduct for Educators

SECTION VI Affida vit

Complete the Affidavit section by Signing and dating the application Your signature certifies that all of the information provided in the application is correct and true Misrepresentationfalsification may result in professional discipline and the revocation of your Pennsylvania certificate

COMPLETING H IE APPLICATION The primary reason for delay s in processing certification applications is missing or incomplete information on the 338 G form andor miss ing documentation If there is missing or incomplete information andor missing documentation your a pplication will not be processed a nd will be retu med to you All signatures and corresponding dates must be withi n one year of application submission

Before mailing review the application and ensure

o The information entered on the 338 G form is complete and accurate (ensure that y ou have enclosed both pages of the 338 C form)

[J A US Licensed Physician has signed the form if applicable o All required documentation is enclosed o The 338 G form has been signed and dated o Enclose a US Money Order for appropriate fee made payable to the Commonwealth of Pennsylvania with

your application The Bureau of School Leadership and Teacher Quality is unable to accept personal checks cash or credit cards The non-refundable fee will be retained by the Commonwealth whether or not the transaction results in the issuance of a certificate

Mail the General Application-Form POE 338 G US money order and supporting documents to

Bureau of School Leadership and Teacher Quality Pennsylvania Department of Education 333 Market Street 3 rd Floor Harrisburg PA 171 26-0333

Please Note [fyou are pursuing cel1ification directly through a Pennsylvania teacher preparation program the application should be submitted to the collegeuniversity Please bring your completed application packet to the college university-do not mail to POE

Page 4 of 5

CO DES for Q uestion 11-2 on PD E 338G form updated 7120 I 0 Bloomsburg University of Pennsylvan ia is approved to recommend certification in the areas marked as bull

SUBJECT AR EAS AN D CODES

INSTR UCTIONAL ARE AS (type 61)

C A REA

1200 AGRICULTURE -12 1405 ART K-12

+ 1603 BUSCOMPUTERIINFO TECH K-12

+ 8825 CITIZENSHIP EOVCATION 7-12

+ 3200 COMMUNICATION 7-12 2361 COOPERATIVE EO 7-1 2

+2840 EARLY CHILDHOOD N-3

2810 ELEMENTARY K-6

+ 3230 ENGLISH 7-12 4820 ENVIRONMENTAL EDUCATION K-12 5600 FAMILYCONSUMER SCI -12 4810 HEALTH K-1 2 4805 HEA L TH amp PHYSICAL ED 1lt-12 6420 LIBRARY SCIENCE K-12 1668 MARKETINGIDISTRIBUTIVE ED TEACHER COOR 7-1 2

+6800 ~ATHEMATICS 7-12 2850 MIDDLE LEVEL ENGLISH 7-9 2860 MIDDLE LEVEL MATHEMA TICS 7-9 2870 MIDDLE LEVEL CITlZENSHIP EDUCATION 7-9 2880 MIDDLE LEVEL SCIENCE 7-9

+7205 ~IUSIC K-12

7650 READING SPECIALIST K-12 5215 SA FETY EDDRIVER ED7-12 8865 SOCIAL SCIENCES 7-12 8875 SOCIAL STUDIES 7- I 2 6075 TECHNOLOGY EDUCATION K-1 2

FOREIGN LANGUAG ES 4005 ARABIC K-1 2 4405 CHINESE K-12

+ 441 0 FRENCH K-12

+4420 GERMAN K -12 4010 GREEK K-12 4020 HEBREW K-12 4430 ITALIAN K-12 4440 JAPANESE K-12 4025 KOREAN 1lt-12 4030 LATIN K-12 4450 L1THUAN IAN K-12 4460 POLlSHK-1 2 4470 PORTUGUESE 1lt-12 4475 RUMANIAN 1lt-1 2 4480 RUSSIAN 1lt-1 2 4040 SANSIltRITIlt-12 4485 SLOVAK 1lt-12

+4490 SPANISH K-12 4493 UKRAINIAN K-12 4495 VIETNAMESE K-1 2

SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12

8440 EARTH AND SPACE SCIENCE 7-12

8450 GENERAL SCIpoundCE 7-12

+8470 PHYSICS 7-12

SPECIAL EDUCAT IO

+9205 HEARING IMPAIRED K-12

+9265 SPEECIl amp LANG IMPAIRpound) N-12 9290 VISUALLY IMPAIRED 1lt-1 2

+9225 SPECIAL EDUCATIOX N-12

EDU C ATION SP ECIALIST AREAS (type 31)

1830 DENTAL HYGIENIST -12

+ 1836 ELEMENTARY SCHOOL COUNSELOR K-6 18-0 HOME AND SCHOOL VISITOR -12

+ 1825 INSTRUCTIONAL TECHNOLOGY SPECIALIST K-12 1865 NUTRIT ION SERVICE SPECIALIST 1lt-1 2

+ 890 SCHOOL URSE K-12 1875 SCHOOL PSYCHOLOGIST K-1 2

+ 1837 SECONDARY SCHOOL COUNSELOR 7-12 9800 SOCIAL RESTORATION 7-12

SUPERV ISO RY AREAS (type 76)

CODE ARFA 14 15 ART SIPERVISOR 3215 COMMINICATION (ENGLISH) SUPERVISOR 2615 COMPREHENSIVE VOCATIONAL ED SUPERVISOR 2515 COOPERATIVE EDUCATION SUPERVISOR

+2915 CliRRIC lI U v AND INSTRUCTION SUPERVISOR 2827 EARLY CHILDHOOD SUPERVISOR 2815 ELEMENTARY EDUCATION SUPERVISOR 4897 ENVIRONMENTAL EDUCATION SUPERVISOR 4415 FOREIGN LANGUAGES SUPERVISOR 4815 HEALTH amp PHYSICAL EDUCATION SUPERVISOR 591 5 INDUSTRIAL ARTSffECHNOLOG Y ED SUPERVISOR 1829 INSTRUCTIONAL TECHNOLOGY SPEC SUPERVISOR 6415 LIBRARY SCIENCE SUPERVISOR 6815 MATHEMATICS SUPERVISOR 121 5 MUSIC SUPERVISOR 2930 PUPIL PERSONNEL SERVICES SUPERVISOR 76 15 READI NG SUPERVISOR 5227 SA FETY EDDRIVER EDUCATION SUPERVISOR 181 5 SCHOOL GUIDANCE SERVICES SUPERVISOR 189 1 SCHOOL HEALTH SERVICES SUPERVISOR 1877 SCHOOL PSYCHOLOGICAL SERVICES SUPERVISOR 1855 SCHOOl SOCIAL SERVICES SUPERVISOR 84 15 SCIENCE SUPERVISOR 88 15 SOCIAL STUDIES SUPERVISOR

+92 15 SPECIAL EDCCATION SUPERVISOR

ADM INISTRATIVE amp LETTER OF ELIGIBILITY AREAS

+ t lI S PRINCIPAL K-12 2300 VOCATIONAL ADMINISTRA TlVE DIRECTOR 1150 DISTRICT SUPERINTENDENT 1155 ASSISTANT DISTRICT SUPERINTENDENT 1160 INTERMEDIATE UNIT EXECUTIVE DIRECTOR

11 65 ASSISTANT IU EXECUTIVE DIRECTOR

Hlecti ve September I 200 I EtTecti ve September I 2003

Page 5 of 5

POE Bureau of School Leadership and Teacher Quality 3

PDE Bureau of School Leadership and Teacher Quality


NOTE These instructions and forms also can be printed from

wwwbloomueduformsPACertificationApplicationpdf

Bloomsburg Universityrsquos Checklist

Have you

Included a United States money order for $100 payable to Commonwealth of

Pennsylvania

Included form ―General Application Form PDE 338G

Obtain original signature of your physician if this is your first

PA certificate

OR

If this is your second certificate the physician signature is not

needed again however please attach a copy of your first

certificate

Included form ―CollegeUniversity Verification Form PDE 338C

If you are applying for principal or a supervisory certificate included

PDE Form 338V ―Verification of Experience for each employer

For some applicants If you did not specify BU code 2646 to get your

PRAXIS scores or if you are unsure have you included a photocopy of all

pages of your PRAXIS score report

Optional If you have not yet taken or have not passed all of your

tests list below the test date when you will complete them

Optional If you need a ―Temporary Substitute Teaching Letter have you

checked this box and returned this page with your application This

letter can be done only after all requirements are finished It can be

mailed to you the same day Bloomsburg University sends your certification

application to the Pennsylvania Department of Education

Optional Have you enclosed a self-addressed stamped envelope to

receive a temporary substitute teaching letter and a confirmation note

showing the date on which your application was sent from Bloomsburg

University to the Pennsylvania Department of Education

NOTE Applications submitted to Bloomsburg University near one of the commencements

(December May August) may take longer to be processed Expect three weeks at

Bloomsburg after grades are posted and degrees are granted and everything is complete

and approximately eight weeks for processing at PDE Except if you noted above that

you are awaiting test scores or except for anticipated graduation at the end of this

semestersummer you will be notified by phone or mail if your application is missing

something Otherwise confirmation will be sent to you the same day the application

is mailed to PDE Incomplete applications will be held six months then returned to

you






o

o

o





4







Initial

Initial

Initial

Initial

Initial































---

---

PDE USE ONLY





3 Address

CityStateZip Code

6 Telephone



Last First MI




5 o Male o Female

7 E-Mail Address


0 Yes

0 No




SECTION III







LJ_ Date



Page I of 5

I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5







o

o

o





4







Initial

Initial

Initial

Initial

Initial






























of3 POE 338C (Revised 6110)

---

---

PDE USE ONLY





3 Address

CityStateZip Code

6 Telephone



Last First MI




5 o Male o Female

7 E-Mail Address


0 Yes

0 No




SECTION III







LJ_ Date



Page I of 5

I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5































---

---

PDE USE ONLY





3 Address

CityStateZip Code

6 Telephone



Last First MI




5 o Male o Female

7 E-Mail Address


0 Yes

0 No




SECTION III







LJ_ Date



Page I of 5

I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5























---

---

PDE USE ONLY





3 Address

CityStateZip Code

6 Telephone



Last First MI




5 o Male o Female

7 E-Mail Address


0 Yes

0 No




SECTION III







LJ_ Date



Page I of 5

I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















of 5


---

---

PDE USE ONLY





3 Address

CityStateZip Code

6 Telephone



Last First MI




5 o Male o Female

7 E-Mail Address


0 Yes

0 No




SECTION III







LJ_ Date



Page I of 5

I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















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I










C Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

0 Yes 0 No

D Yes o No







Page 2 of 5




















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5





















Page 3 of 5




















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5





















Page 4 of 5




C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5





C A REA






2810 ELEMENTARY K-6



+7205 ~IUSIC K-12



+ 441 0 FRENCH K-12



SC IENCF AREAS

+8405 BIOLOGY 7-12

8420 CHEMISTRY 7-12



+8470 PHYSICS 7-12

SPECIAL EDUCAT IO


















Page 5 of 5


INSTRUCTIONS FOR COMPLETING APPLICATION - · PDF fileinstructions for completing application...

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