Application To Extend The Provisional Foreign Teacher Teaching Certificate Form
ADVERTISEMENT
1
2A
PPLICATION TO
E
P
XTEND THE
ROVISIONAL
F
T
T
C
OREIGN
EACHER
EACHING
ERTIFICATE
– C
A
D
E
U
RIZONA
EPARTMENT OF
DUCATION
ERTIFICATION
NIT
Phoenix Office:
P.O. Box 6490, Phoenix, AZ 85005-6490
Telephone: (602) 542-4367
This certificate is required for a teacher or professor from any foreign country, state, territory or possession of the United States contracted through
the Foreign Teacher Exchange Program or other foreign teacher recruitment programs approved by the United States Department of State. It is issued
in the areas of early childhood education, elementary education, secondary education, special education, and career and technical education. The
Provisional certificate is valid for 1 year and may be extended 1 year.
G
I
I
:
ENERAL
NSTRUCTIONS AND
NFORMATION
Please submit the following:
□
Completed Application for Extension of the Provisional Foreign Teacher Certificate.
o
Answer every Criminal History question, sign and date the application
If you answer “Yes” to any Criminal History questions, submit a completed
o
Explanation of Incident
form. If you have
more than one incident to report, you must disclose every incident separately.
□
A photocopy of your valid Arizona Department of Public Safety Identity Verified Prints (IVP) fingerprint card (plastic).
□
A check or money order for the amount due, made payable to the Arizona Department of Education (ADE). Credit card
payments (Visa and MasterCard) are accepted for in-person applicants at the Phoenix Certification office. Fees are not
refundable. Cash will not be accepted.
□
Verification letter of intent to hire from the contracting governing board, the education service agency, the charter holder, or
the Arizona Board of Regents indicating grade level and subject area placement and signed by the district Superintendent or
HR director.
S
1: P
I
ECTION
ERSONAL
NFORMATION
(Type or print in blue or black ink.)
Social Security Number: _______-_____-________
Date of Birth: _____/_____/________
Gender: M / F
(For identification purposes only)
Full Legal Name: ____________________________________________________________________________________________________
Last
First
Middle
Mailing Address: ____________________________________________________________________________________________________
Street Number or P.O. Box
City
State
Zip
Telephone: (______) ______-________
Email Address: ___________________________________
Check box if you want to receive
ADE updates via email.
(Home)
(Home)
Ethnicity: ____Asian or Pacific Islander
____Black or African-American (Not-Hispanic)
____Hispanic or Latino
____White (Not-Hispanic)
____American Indian or Alaskan Native
____Other
S
2: C
ECTION
ERTIFICATION TYPE AND FEES
T
C
:
EACHING
ERTIFICATES
___ ELEMENTARY (K-8)........................................................
$20
___ EARLY CHILDHOOD...........................................................
$20
___ APPROVED AREA ELEMENTARY -
___ SECONDARY (7-12)(ONE APPROVED AREA)-
AREA______________________......................................
$20
AREA____________________..............................................
$20
___ ARTS EDUCATION (PreK-12).........................................
$20
___ ADDITIONAL APPROVED AREA SECONDARY-
(Select One:)
AREA _____________________ ..........................................
$20
___ART ___DANCE ___DRAMATIC ARTS ___MUSIC
___ PREK-12 PHYSICAL EDUCATION................................
$20
S
E
C
(K-12)
:
PECIAL
DUCATION
ERTIFICATES
___ CROSS-CATEGORICAL (ED, LD, ID, O/HI).................
$20
___ INTELLECTUAL DISABILITY............................................
$20
___ EARLY CHILDHOOD (BIRTH TO AGE 5).....................
$20
___ SEVERELY AND PROFOUNDLY DISABLED .................
$20
___ EMOTIONAL DISABILITY..............................................
$20
___ VISUALLY IMPAIRED ........................................................
$20
___ HEARING IMPAIRED.......................................................
$20
___ LEARNING DISABILITY.................................................
$20
C
T
E
C
(K-12):
AREER AND
ECHNICAL
DUCATION
ERTIFICATES
___ AGRICULTURE.................................................................
$20
___ HEALTH CAREERS..............................................................
$20
___ BUSINESS AND MARKETING........................................
$20
___ INDUSTRIAL TECHNOLOGY.............................................
$20
___ FAMILY AND CONSUMER SCIENCES..........................
$20
E
:
NDORSEMENTS
___ STRUCTURED ENGLISH IMMERSION......................... $60
** R
A
R
S
A
C
. **
EQUIREMENTS MAY BE SUBJECT TO CHANGE AND ARE FULLY REFERENCED IN THE
RIZONA
EVISED
TATUTES AND
DMINISTRATIVE
ODE
Revised 3-28-2016
.
.
/
-
Page 1 of 2
WWW
AZED
GOV
EDUCATOR
CERTIFICATION
ADVERTISEMENT
0 votes
Related Articles
Related forms
Application To Extend Provisional Teaching, Secondary Stem, Or Administrative Certificate With Structured English Immersion (sei) Endorsement Deficiency Form
Legal
Form 872-f - Consent To Extend The Time To Assess Tax Attributable To Items Of A Partnership Or S Corporation That Have Converted Under Section 6231 M Of The Internal Revenue Code - Department Of The Treasury
Legal
Form 872-q - Notice Of Termination Of Special Consent To Extend The Time To Assess Tax Attributable To Items Of An S Corporation - Department Of The Treasury
Legal
Form 872-n - Notice Of Termination Of Special Consent To Extend The Time To Assess Tax Attributable To Items Of A Partnership - Department Of The Treasury
Legal
Form 9248 - Agreement To Extend The Time To File A Petition For Adjustment By The Tax Matters Partner (person) With Respect To Partnership Or Subchapter S Items - 1991
Financial
Form 872-f - Consent To Extend The Time To Assess Tax Attributable To Items Of A Partnership Or S Corporation That Have Converted Under Section 6231 M Of The Internal Revenue Code
Financial
Related Categories
Parent category: Legal