Certification Appendix 10
Letter of Intent
Name
*
First Name
Last Name
I declare my intent to
Submit theory papers by email five weeks from today's date
Meet the Certification Commission at their annual spring meeting
Meet the Certification Commission at their annual fall meeting
Request
*
Associate Educator
Certified Educator
Review for Alternate Certification Process
Inactive to Active Status
Date your Educator Candidate/Associate Educator status expires
-
Month
-
Day
Year
Date
Certified Educator's Name
Optional
CPE Center Name
*
Preferred Email
*
example@example.com
Preferred Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Phone Number
*
-
Area Code
Phone Number
Religious Faith Group and Endorser
*
Cultural Heritage
Optional
You may request one (1) person of a certain demographic to be on your committee (e.g. African American member, GLBT member, etc.) Do not list a particular person. These requests will be honored as feasible and based on availability of current commission members and/or theory paper readers.
Optional
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Submit
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