ALERT: Do not use this form for
Converting a 3-year Provisional
teaching certificate to a 6-year
Standard requires an "Application to
Convert a Provisional..."
ARIZONA DEPARTMENT OF EDUCATION - CERTIFICATION UNIT
Mailing Address: P.O. Box 6490, Phoenix, AZ 85005-6490 • Telephone: (602) 542-4367
Verification of PreK-12 Teaching Experience
This form must be completed by a district superintendent or human resources
director, or by a charter or private school administrator. This form will NOT be
accepted if any section of the form is completed or altered by the applicant.
Part 1: Teacher Information
Educator ID or Social Security
Part 2: Verification of teaching experience. Include full-time teaching experience ONLY. Do NOT
include part-time teaching, substitute teaching, or paraprofessional experience.
End Date of
Subject or Specialized
Area(s) (e.g., ESL, Gifted,