Verification of Program Completion and Character - ospi washington teacher certification

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OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
Web
Old Ca
(360)
Professional Certification
OL
Site:
pitol Building, PO BOX 47200
72
E
YMPIA WA 98504-7200
ht
5-6400 TTY (360) 664-3631
-M
tp:/ /www.k12.wa.us/certification/
ail: cert@k12.wa.us
VERIFICATION OF PROGRAM
COMPLETION AND CHARACTER
ALL SECTIONS must be completed. Send it to the institution/organization* where you completed your teacher preparation and certification
program. This form, when returned to you, is to be included with your application packet.
*If you were trained outside the U.S. and Canada, use Form SPI 4030 instead of this form.
SECTION A
TO BE COMPLETED BY APPLICANT
1. NAME LAST FIRST MIDDLE MAIDEN/FORMER NAME
2. ADDRESS 3. DATE OF BIRTH
CITY/STATE/ZIP 4. SOCIAL SECURITY NO. (OPTIONAL)
5. TELEPHONE: 6. E-MAIL
BUSINESS ( ) HOME ( )
SECTION B
TO BE COMPLETED BY COLLEGE/UNIVERSITY
The above named is an applicant for teacher certification in Washington State. To be valid, this form must be signed by the program director of the
organization or 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 teacher preparation and certification program. A stamped signature must be initialed by the person
using the stamp. RETURN THIS FORM TO THE APPLICANT.
A. Has this applicant completed your state-approved teacher education program? A. YES NO
Date of program completion.
If no, what were the deficiencies?
B. Did the applicant complete a supervised student teaching and/or internship as part of the program? B. YES NO
C. Did the program include a defined course of study? C. YES NO
D. Was he/she eligible for certification in your state at the completion of the teacher preparation program? D. YES NO
If no, what were the deficiencies?
For F & G, 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 supervised,
classroom-based field experience/internship that includes instruction in that content area.
E. Area in which applicant is recommended for certification. Please indicate area and grade level(s).
AREA GRADE LEVEL(S)
F. Other approved content area/endorse- AREA GRADE LEVEL(S)
ment programs that applicant has
completed:
G. 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?
YES List any reason(s) this applicant should not be certified in Washington.
NO
NAME OF INSTITUTION/ORGANIZATION DATE
ADDRESS By signing this form I
attest that the above
CITY/STATE/ZIP information is true and
accurate to the best of
TELEPHONE E-MAIL my knowledge.
( )
NAME (PRINTED) AND TITLE (Program Director of Organization/Chairperson/Dean of Education Department/ SIGNATURE
Certification Office)
FORM SPI/CERT 4020E (Rev. 5/18) RETURN COMPLETED FORM TO THE APPLICANT


How do I get my teacher certification in Washington state? If you're interested in teaching in Washington State, the traditional pathway includes four broad steps: Get a bachelor's degree from a regionally accredited university. Pass the required exams for Washington teacher certification: the WEST-B Basic Skills exam and the NES/WEST-E content knowledge exam.

• Washington State School for the Deaf
• Washington State Office of Superintendent of Public Instruction
• Washington State Institute for Public Policy
• Verification of Program Completion and Character
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