Teacher Certification Forms & Documentation 

• Background Checks and Criminal Disclosures - affects ALL students
• Forms for Current Students, 
• Forms for Interns, 
• Graduate Program
• Forms for Supervisors and Mentor Teachers, 
• Forms for Certification
• Numerical INDEX of Forms

Disclosure/release forms - All Students

• F023-a Michigan : Police Records Check

• F024-a Ontario: Police Records Check

• F025-b  Criminal History Disclosure/Release  
  
  Reporting requirements: Any teacher convicted of any felony, and/or select misdemeanors must self-disclose the conviction to the Michigan Department of Education and their School District immediately, or be subject to additional criminal charges for fraud.  Convictions of specified misdemeandors or any felony will result in an administrative hearing to revoke any/all teacher certification.  Conviction on certain offenses will result in immediate suspension of any/all teacher certification.  Conviction on specified Listed Offenses will prohibit employment in any capacity by any K-12 institution.   LSSU students must self-disclose any charges or convictions related to all criminal offenses.  No individual with a conviction of a listed offense may be enrolled in the teacher certification program, individuals with specified misdemeanors or certain offenses leading to suspension are advised that they may be denied access to field placements by schools which will preclude program completion, and to teacher certification following the Administrative Hearing with scary MDE staff members.  

Section A: Forms for Current Students:   

1. Application to School of Education
   Application Guidelines - The application deadline is the 2nd Friday of October, August and and of February at noon.  Download the file and review the checklist of requirements.  You must complete all admission requirements during the semester in which you apply.  Admission status will not be finalized until the MTTC scores are received and grades are finalized.  NOTE: students enrolled in CS101 beginning with the spring 2004 must keep their lab activities as documentation of their technology skills for inclusion in the application.
   

2. Guidelines for Field Experiences PRIOR to admission. (directions updated 18 Dec 03) Documentation for this work is SUMMARIZED on Form F310.  Evidence of work outside of the classroom setting is to be submitted using Form F315.  Work associated with your TE250 course is to be submitted on Form F320.   This experience must be both recent and relevant:  60  hours can be completed in 3 years preceding formal application;   20 hours must be completed within the calendar year prior to application
    

   • F310-b Summary of Teaching/Child Related Experiences (pdf)  This revised form tabulates field experiences documented with F315 and F320.  Submit with application to School of Education. (revised 18dec03) (F310 as a Word .doc)

   • F315-b Experiences with Children and/or Adolescents (pdf) (revised 18dec03) (F315 as a Word .doc)

   • F320-b Field Experience Log for TE250  (revised 29aug05) (F320 as a Word .doc)
     

3. Field Experience Guidelines for use AFTER Admission

   • NEW VERSION - F325-b -a Field Experience Log for TE301 and above (includes reflective narrative) (revised 29aug05) .

   • F330-a Evaluation of Professional and Ethical Behavior (PEB) full version (pdf) (revised 18dec03)
     

4. Evaluation of Professional Dispositions
   F301-a Commitment Letter.
   F302-a  Evaluation Of Dispositions. (PINK FORM) Required of all students in TE250, TE301, TE411 and TE430.  Optional for any student at any time.

   Technology and the 7th Standard

   • Alignment of PTfT training modules to TE curriculum (table)

   • F340-a Technology Assessments and required artifacts
      

5. Student Teaching Handbook & Guidelines for Supervision
    

   To begin your student teaching in :	The Application is due:
   Start of school in August	1st Friday in December
   After the Christmas break in January	1st Friday in October

    

   • Effective for the Fall 2007 all individuals placed into the student teaching internship MUST meet ALL of the following criteria prior to placement in a K-12 classroom:
     
     a) Completion of all required EDUC courses with grade of B- (2.70) or higher
     b) Completion of required courses in the education cognates, teaching major and/or teaching minor(s) with GPA of 2.70 or higher and no grade below a "C" (2.0).
     c) Completion of elementary planned program requirements with GPA of 2.70 or higher and no grade below a "C" (2.0) - elementary candidates only.     
     d) A candidate rating of 1, 2 or 3 on LSSU Form F365 the Pre-Internship Exit Interview
     
     This policy will apply to individuals currently placed and those seeking new placements for the fall 2007 or later.  Individuals may take summer courses in order to meet the criteria, however official grades must be entered into the system, and/or transferred from other institutions, by the end of the  marking period.
     Please further note that the previous policy was more restrictive and based on the presumption that an individual would graduate prior to student teaching.  Effective with the summer 2007 candidates will be allowed to select between teacher certification programs where student teaching is a part of the bachelor's degree, or student teaching is completed after earning the bachelor's degree.  This policy establishes the criteria for placement independent of graduation, but clarifies the necessity of adequate preparation in both pedagogy and academic content as prerequisite to teaching.

   • Effective for the Fall 2008, student teaching is available as a one-semester placement.  Teacher candidates must obviously still meet the same performance standards.  Student teaching is one semester (15 weeks of the university semester) of full-time, full-day participation in the school.  The intern must carry the full-responsibility for an extended period where all planning, implementation, assessment and other teacher-duties are successfully carried out by the intern.  Effective with the Fall 2008 all interns will prepare Teacher Work Sample which documents their effectiveness in causing student learning in the classroom.

   Internship Application Guidelines (revised 25Aug04)

   • F350-a Application for Intern Placement (word, pdf ) 

   • F351-a Disclosure of Family/Personal Relationship in Placement School

   • F355-c Intern Requirements Checklist

   • F365-a Pre-Internship Interview  

SECTION B: Forms often used by Interns

• F005-b   Intern Information (word)

• F010-b   Mentor Information (word)

• F015-a   Mentor Teacher Schedule (word, pdf, WP5)

• F020-b   Orientation/First Supervisor Visit (word)

• F025-b  Criminal History Disclosure/Release

• F030-b   Intern Contract (word)

• F035-a   Code of Ethics (pdf)

• F040-a   Activities Checklist (word, pdf, WP5)

• F045-a   Observation Request (word, pdf, WP5)

• F050-a   Focused Observation Guide (word, pdf, WP5)

• F055-b   Attendance Log (word)

• F060-a   Class Description Profile (word, pdf, WP5)

• F065-a   Class Instructional Profile (form deleted 29Jul04)

• F075-a   Activities Log (word, pdf, WP5)

• F080-a   Personal Goals/Objectives (word, pdf, WP5)

• F085-b   Lesson Plan (DOC or RTF)

• F090-a   Reflection on Lesson/Self-Evaluation (word, pdf, WP5)

• F095-b   Unit Plan (DOC or RTF)

• F100-a   Critique of Unit Plan (word, pdf, WP5)

• F104-a  Technology Skills Survey (word) (new 20Sep04)

• F105-b   Incorporating Technology (word)
  
  FORMS REQUIRED AT THE END OF STUDENT TEACHING:
  

• FORM F200-F Application for Initial Provisional Certification  
  Use this form for ONE semester student teaching internships (revised 18Mar08) 
   

CANADIAN STUDENTS MUST APPLY DIRECTLY TO THE ONTARIO COLLEGE OF TEACHERS - pick up the application entitled "Teachers Trained Outside Ontario" from the School of Education or go online to their website for additional information www.oct.ca.  
Please Read the  OCT Guide sheet with additional directions for LSSU graduates.  
You will need these two forms:
F220-b   Ontario Student Information Release (revised  5apr05)  
F225-a MDE-OCT Letter of Professional Standing (required for Ontario candidates)

SECTION C: Forms used by Supervisors  (chart of forms needed for periodic reviews)

• F110-a   University Supervisor Visit Record (word, pdf, WP5)

• F115-b   1st Progress Report (word)

• F120-b   Classroom observation (Narrative) (word)

• F125-b   Classroom observation (Rubric) (word)

• F130-c  Periodic Formal Evaluation (revised 9Sep04) 

• F140-a   Intern Plan of Assistance Guidelines (word)
  

• F500-b   Mentor Teacher Application for SBCEU credits.  (Revised Jan-07) Application must be received by January 10 for fall semester supervision, and by June 10 for spring supervision.

SECTION D: Certification Forms - used to apply with LSSU for your certificate/renewal

• Overview of Certification Procedures

• F025-b  Criminal History Disclosure/Release  
  - REQUIRED WITH ALL APPLICATIONS
  

• FORM F200-F   
  Application for Initial Provisional Certification (revised 18Mar08)
  Earlier versions include: F200-D for two semester student teaching

• F205-C    (revised 18Mar08)  Application for Provisional Renewal

• F210-C   (revised 18Mar08) Application for Additional Endorsement

• F215-C   (revised 18Mar08) Application for Professional Certificate (pdf)

• F220-b   Ontario Student Information Release (revised  5apr05)

• F225-a MDE-OCT Letter of Professional Standing (required for Ontario candidates)

• F230-a  Verification of Teaching Experience (optional)
  

• Are you certified in another state, or has your Michigan teacher certification expired?  You will need to apply directly to the Michigan Department of Education.