Application Packet for Candidates
P-12 Reading Endorsement Program
The following items need to be completed and submitted for approval as a candidate for the P-12 Reading Endorsement Program.
1. Candidate Application Form (form included in packet)
2. Endorsement Area Program Self-Verification Form (form included in packet)
3. Copy of clear renewable Georgia teaching certificate
4. Copy of college transcript
5. Written statement of philosophy of reading instruction
6. Written recommendations from current principal and one other person in a
supervisory position
7. Verification by school system of certification and a minimum of three years of teaching experience (form included in packet)
ALL ITEMS MUST BE SUBMITTED TO NORTHEAST GEORGIA PRIOR TO BEGINNING PROGRAM
Mail or fax to:
Brenda Mercer
Northeast Georgia RESA
375 Winter Street
Winterville, GA30683
Fax: 706.742.8928
For more information contact Janice McLeroy at (or Brenda Mercer ()
Northeast Georgia RESA Endorsement Program
Candidate Application Form
Endorsement Program______
Candidate’s Name______
(As it appears on teaching certificate)
Gender (M F)____ Hispanic (Y N)_____ Ethnicity ______
SS#______System______
School______Phone #______
School Address______
______E-mail Address:______
Home Address______
______Phone #______
Teaching Experience ______yearsCertification______
Level/Subject Area ______
Candidate’s Commitment
I understand that in order to receive credit for these endorsement classes I must:
*complete all required coursework and assignments
*be present for a minimum of 90% of the class time (In 50 hour courses
you can miss no more than 5 hours with instructor’s permission. Make-up
assignments must be completed for any class absence.)
*submit all required payments to Northeast Georgia RESA or verify
payment from another source (local system, PRISM, etc.)
______
Candidate’s Signature Date
Recommended by:______
Principal/Designee Signature Date
Approved by: ______Professional Development Director Date
Endorsement Area Program Self-Verification Form
Candidate’s Name: ______
School System: ______
I am a candidate for the P-12 Reading Endorsement Program. I hold a current teaching certificate in the following area(s):
______
I am a candidate for the P-12 Reading Endorsement Program and have teaching and/or student teaching experience in the following area(s):
______
______
I verify that I understand the overall requirements, expectations, evaluation guidelines, program completion expectations, processes, and procedures for the P-12 Reading Endorsement program.
______
(Signature)(Date)
Mail to:
Brenda Mercer
Northeast Georgia RESA
375 Winter Street
Winterville, GA30683
Fax: 706-742-8928
Office Use Only:
Application form: ______Approved: ______
Self-verification form: ______
Certificate: ______Fees: ______
College transcript: ______
Statement of philosophy: ______
Recommendations: ______
System Verification: ______
Northeast Georgia RESA Endorsement Program
Candidate Eligibility Form—System Verification of Certification and Experience
Candidate’s Name______
System______School______
CERTIFICATION
The above candidate for the P-12 ReadingEndorsement Program holds a current certification in the following area(s).
______
TEACHING EXPERIENCE
The above candidate for the P-12 ReadingEndorsement Program has teaching and/or student teaching experience in the following area(s). (Please include the number of years in each area.)
______
As a designee of the ______School System, I verify that the candidate for the P-12 Reading Endorsement Program has the certification and experience as listed above.
______
SignatureDate
______
Title
Mail to:
Brenda Mercer
Northeast Georgia RESA
375 Winter Street
Winterville, GA30683
Fax: 706-742-8928