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CODE) TELEPHONE CITY STATE ZIP CODE PERMANENT ADDRESS STREET (AREA CODE) TELEPHONE CITY STATE ZIP CODE E-MAIL ADDRESS (IF AVAILABLE) LIST, IN ORDER OF PREFERENCE, THE GRADES, SUBJECTS AND/OR POSITIONS FOR WHICH YOU ARE APPLYING: 1. 2. 3. CERTIFICATION (LIST ALL AREAS IN WHICH YOU HOLD VALID PENNSYLVANIA AND/OR OUT-OF-STATE TEACHING CERTIFICATES. NOTE: APPLICANTS HOLDING A CERTIFICATE FROM ANOTHER STATE MUST OBTAIN A PENNSYLVANIA CERTIFICATE IN ORDER TO TEACH IN PENNSYLVANIA PUBLIC SC.

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