Educator Certification
Forms
Applications for Certificates • Registration/Updates • Requests for Approval • Statement of Assurance
Attention!Appeal Forms 77-17 and 77-18, Higher Education Form 77-39, NBPTS Form 77-23, NCLB District Reports, Providers Of Workshops, Conferences, Seminars, Etc. Forms 77-21a & 77-21b, Registration and Updates of Certificates Forms 77-08 & 77-36, and Statements of Assurance Forms 73-97 & 73-98 HAVE BEEN MOVED to the Educator and School Development Forms Page.
Below you will find the online version of the forms from our office. Each form is saved in the PDF format. Please take the printed form and submit to your local Regional Office of Education.
Note: The following documents are in 
.pdf format and may contain form fields. In order for them to work correctly please visit http://www.adobe.com to download the latest version of Adobe Reader.
.pdf format and may contain form fields. In order for them to work correctly please visit http://www.adobe.com to download the latest version of Adobe Reader.
Requests
for Priority Review of Certification Applications
Instruction
Sheet for filling out a Form ONLINE
Applications for Certificates
| Form # | Form Name |
|---|---|
| 73-01 (12/11) |
Application for Alternative Certificate |
| 73-03C (12/11) |
Teaching Certificates: Early Childhood,
Elementary, Secondary, Special, Substitute, Provisional
Vocational, Transitional Bilingual, Resident Teacher,
Part-time Provisional Option to split a special certificate to elementary and secondary certificates |
| 73-03D (12/11) |
Application for School Service Personnel or Administrative Certificate |
| 73-03E (11/11) |
Application for Master Certificate |
| 73-03F (12/11) |
Visiting International Teacher Certificate |
| 73-05 (3/10) |
State-Approved Program Verification |
| 73-23 (8/09) |
Provisional Vocational Certificate |
| 73-52 (1/12)  |
Endorsement of Elementary, Secondary or Administrative Certificate |
| 73-52A (12/11) |
Application for Teacher Leader Endorsement of Issued Certificate |
| 73-63 (9/09) |
Request for Issuance of Provisional Certificate |
| 73-86 (12/11) |
Short-term Emergency in Special Education |
| 73-91 |
Obsolete per PA 97-607 |
| 73-91A (11/11) |
Foreign Credentialing for Substitute and/or Para-Professional Certificate |
| 73-93 |
Obsolete per PA 97-607 reinstatement requirements have changed |
| 73-93A (12/11) |
Reinstatement Application |
| 73-94 (12/11) |
Interim Certification as School Counselor Intern |
| 73-99 | Obsolete per PA 96-0689 |
Registration/Updates
of Certificates
| Form # | Form Name |
|---|---|
| 73-10 (12/11) |
Certificate Registration Form |
| 73-71 (12/11) |
Certification Update/Duplicate Certificate Request/Name or address change |
| 73-83 (1/10) |
Verification of Teaching Experience for Removal of Limitations on Limited Learning Behavior Specialist I (LBS I) Endorsement |
| 73-85 (1/10) |
Request for Review of File to Remove Limitations on LBS I |
| 73-92 (1/10) |
Certificate of Completion for LBS I Training Sequence |
Requests
for Approval
| Form # | Form Name |
|---|---|
| 73-26 (5/10) |
Request for Evaluation of Approval Areas of Special Education |
| 73-42 (8/10) |
Approval of Other Special Education Personnel |
| 73-44 (2/11) |
Notification of School Service Personnel Intern Eligibility Status |
| 73-49 (1/10) |
Approval as a Bilingual or ESL Teacher |
| 73-51 (12/08) |
Request for Approval of a Speech and Language Paraprofessional |
| 73-53 (1/10) |
Educational Interpreter Log |
| 73-67 (1/11) |
Bilingual Special Education Approval |
| 73-72 (9/08) |
Nonpublic School Request for Approval of Other Special Education Personnel |
| 73-95 (11/11) |
Paraprofessional Approval/Approval for Paraprofessional Employment in Title I Positions |
| 73-96 (1/10) |
Request for Authorization to Employ Teacher in Position Otherwise Unfilled |
| 77-35 (12/11) |
Request for Approval as an Educational Interpreter |
| 77-36 (1/10) |
Request to Report Status of Bilingual Teacher, Special Education, and Rural School Teacher as Highly Qualified for NCLB Purposes |
Statement of Assurance
The following are downloadable paper forms. To submit Assurance
Statements online, use ECS| Form # | Form Name |
|---|---|
| 77-34 (1/10) |
Assurance of Local Assessment for Paraprofessionals |
