Certified/Licensed Substitute Application

Certified/Licensed Substitute Application
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Educational Training
College or University:*
Graduation Date:*
Degree:*
Major:*
Minor:
Licensure
Date Issued:
Expires:
File Folder Number:
Are you a retired teacher?*

YesNo
Are you a member of the Teachers Retirement Association?*

YesNo
If so, number:
Substitute Work Preferred - Elementary (check all that apply)

Kindergarten1st2nd3rd4th5th6thMusicArtPEMediaECFE/SRSpecial Education
Do you prefer Junior High, Senior High or both?

Junior High OnlySenior High OnlyBoth
Substitute Work Preferred - Secondary (check all that apply)

EnglishSocial StudiesMathScienceArtMusicFCSIndustrial TechPEMediaSpecial Education
Should be Empty:

Educational Training