Get Verification Of Program Completion

O. Box 500 Trenton New Jersey 08625-0500 Attention Verification of Program Completion Filename / path / rev date 05-20-2014. New Jersey State Department of Education Office of Certification and Induction VERIFICATION OF PROGRAM COMPLETION For submission by anyone who has completed a college/university teacher preparation program. A. Basic Information Please print your name as it appears on any documentation that you are required to submit Last Name First Name Middle Name or Initial Street Address City Social Security Number State Date of Birth Phone Number E-mail Address Month Zip Day Year B. To Be Completed by College/University The above named applicant has requested New Jersey teacher licensure. Please complete information in Section B regarding this applicant. To be valid this form must be signed by the dean of the college or school of education the certification officer the chairman 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* Verify your information with your school seal* PLEASE RETURN THIS FORM TO THE APPLICANT. a* Has this applicant completed your teacher education program Yes No If yes please list date of completion* Circle whichever applies b. Was the applicant eligible for certification in your state at the completion of his/her teacher preparation program If no what were the deficiencies c* If student teaching is not identified as student teaching on the transcript how is it described and how was it satisfied d. Major area and/or grade level in which applicant is recommended to teach e. Applicant s date of matriculation C. Certification Name of College/University Address Printed Name of Individual Completing this Form Contact Telephone Number Printed Name Title of Authorizing Officer Chairperson Education Department/Certification Officer Signature of Authorizing Officer College / University Seal Date Applicant please return this form to P. Basic Information Please print your name as it appears on any documentation that you are required to submit Last Name First Name Middle Name or Initial Street Address City Social Security Number State Date of Birth Phone Number E-mail Address Month Zip Day Year B. To Be Completed by College/University The above named applicant has requested New Jersey teacher licensure. To Be Completed by College/University The above named applicant has requested New Jersey teacher licensure. Please complete information in Section B regarding this applicant. To be valid this form must be signed by the dean of the college or school of education the certification officer the chairman 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* Verify your information with your school seal* PLEASE RETURN THIS FORM TO THE APPLICANT.