Form Ot 37 - Verification Of Paid Experience For Permanent Pupil Personnel Service (Pps) And Professional Classroom Teaching Certificates Page 2
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1
2c. N/A
Employment 2
Position: ________________________________________________________________________________________
(Indicate title/subject and grade level)
Full-time:
from: ____/_____/_____
to _____/_____/____
Number of days ________
(mm)
(dd)
(yyyy)
(mm)
(dd)
(yyyy)
Part-time: full-time equivalent days: ________
from: ____/_____/_____
to _____/_____/____
(mm)
(dd)
(yyyy)
(mm)
(dd)
(yyyy)
a. For each school year, the experience averaged 2.5 days per week in the subject area and was completed in
periods of no less than 90 days.
b. For each school year, the experience included at least 45 days of part-time, continuous school experience
in the subject area and consisted of at least one class period each day with a consistent group of students
during such time period.
c. N/A
Employment 3
Position: ________________________________________________________________________________________
(Indicate title/subject and grade level)
Full time:
from: ____/_____/_____
to _____/_____/____
Number of days ________
(mm)
(dd)
(yyyy)
(mm)
(dd)
(yyyy)
Part time: full-time equivalent days: ________
from: ____/_____/_____
to _____/_____/____
(mm)
(dd)
(yyyy)
(mm)
(dd)
(yyyy)
a. For each school year, the experience averaged 2.5 days per week in the subject area and was completed in
periods of no less than 90 days.
b. For each school year, the experience included at least 45 days of part-time continuous, school experience
in the subject area and consisted of at least one class period each day with a consistent group of students
during such time period.
c. N/A
Section III
I verify that the individual listed above gained the paid experience listed above at the public/private school of which I
am the superintendent; or, the approved non-public/independent school of which I am the chief school officer; or
with regard to Speech and Language Disabilities or Students with Disabilities experience only, the Authorized official
listed for the public/private school with which my agency contracts.
Name of school or employer: ________________________________________________________________________
Address of school or employer: _____________________________________________________________________
Print name of administrator: ________________________________________________________________________
Signature of administrator: * _______________________________________________ Date: __________________
Administrative title:*
________________________________________________________________________
Email: _________________________________________________ Phone #: ________________________________
* Signature of the superintendent of schools, community superintendent or borough high school superintendent is
required. If the experience was earned while employed by a private entity for Speech and Language Disabilities or
Students with Disabilities experience, the private entity must submit a copy of the contract with the public school
district.
OT 37 (Rev. 05/2016)
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