Form C-2 - Program Completion Report - Oregon Teacher Standards And Practices Commission
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2Teacher Standards and Practices Commission
Voice (503) 378-3586
Contact.tspc@state.or.us
465 Commercial St NE
Salem, OR 97301
Program Completion Report (Form C-2)
To applicant: Complete the following section and send this form to the director of teacher education at the college or university where you completed
your professional education program.
Name
(Last)
(First)
(Middle)
(Previous)
Mailing
Address
(Street or Box No.)
(City)
(Zip Code)
SSN:
Phone No. Home (
)
Date of Birth:
Work (
)
I AM APPLYING FOR:
FULL-TIME LICENSURE IN OREGON.
ADDED SUBJECT ENDORSEMENT
ADDED AUTHORIZATION LEVEL
To director of teacher education: This applicant has applied for an Oregon license. Please complete sections below in ink.
Teacher Education Program
1) Has the above-named educator completed all requirements for full licensure with no restrictions
Yes
No (If no, please explain)
2)
Date of Completion__________________________________
3)
Please select the levels and endorsements below that most closely align with your state licensure requirements.
At what level(s) is the candidate prepared to teach?
Early Childhood
Elementary
Middle Level
High School
(pre k-grade 4)
(grades 3-8)
(grades 5-9)
(grades 9-12 in a High
School)
Please check the subject area(s) for which the applicant has completed a teacher education program:
Agricultural Science & Technology
Integrated Science
Reading
EC/EL*
EL/ML*
ML/HS*
Art
Japanese
Russian
EC/EL*
EL/ML*
ML/HS*
Biology
Language Arts
Social Studies
Chemistry
Latin
Spanish
Drama
Marketing
Speech
Educational Media PP-12 **
Math, Advanced
Technology Education
ESOL
Math, Basic
Special Education
EC/EL*
EL/ML*
ML/HS*
EC/EL*
EL/ML*
ML/HS
ESOL/Bilingual
Multiple Subject (self-contained at ece/ele)
Early Intervention /Special Ed. I
EC/EL*
EL/ML*
ML/HS*
Multiple Subject (middle level)
Early Intervention/Special Ed. II
Family & Consumer Sciences
Music
Hearing Impaired PP-12**
EC/EL*
EL/ML*
ML/HS*
French
Physical Education
Communication Disorders PP-12**
EC/EL*
EL/ML*
ML/HS*
General Business Ed.
PE, Adapted
Visually Impaired PP-12**
EC/EL*
EL/ML*
ML/HS*
German
Physics
Health Education
*
Endorsements are valid for early childhood/elementary and/or elementary/middle level and/or middle level/high school
** Endorsements are valid for preprimary through grade 12
Verification from Director of Teacher Education:
I verify that the applicant has completed the teacher education program successfully and in good standing.
Director of Teacher Education (Signature)
Date
(
)
College or University
City & State
Phone Number
THIS FORM MUST BE RETURNED TO THE APPLICANT IN A SEALED INSTITUTIONAL ENVELOPE
.
(TSPC.0002 – 03/16/2009)
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