NON-PUBLICSCHOOLTEACHERS
-TO BE SUBMITTED BY EMPLOYING SCHOOL OR SCHOOL DISTRICT-
General Information
♦School districts or school principals must initiate a request for this certificate,not the individual.
All records must be submitted in a complete package, to include:
- Completed Application Formwith all information provided
- Official Transcript bearing seal of institution from all universities attended showing degree earned and date awarded
- Professional Conduct Form with all questions answered and signed and dated by the applicant
- NTE/PRAXIS scores if applicable
- Certification Fee
- Initial Certificate - $50.00 non-refundableprocessing fee (check or money order payable to the Louisiana Department of Education
- Renewal Fee – none required
♦Partial application packages will be returned. If a university will not release transcripts to an individual, please note on the packet that transcripts will be forwarded from the university.
When the complete application package is received from the employing system, a determination will be made regarding applicant’s eligibility for a Non-Public School Temporary Certificate. If additional information is required at that time, applicant will be advised.
♦All PRAXIS exams completed after September 1, 1999, must be submitted electronically to the Division of Certification, Leadership, and Preparation directly from Educational Testing Services, or with the initial application in the form of an original score report.
One who has questions about these requirements or the certification process, should contact the Division of Certification, Leadership, and Preparation at (225) 342-3490 (or toll free at 1-877-453-2721) or email for assistance.
Effective June 16, 2010:The Division of Certification, Leadership, and Preparation will no longer print and mail Louisiana teaching and/or ancillary certificates. You may verify issuance and print a copy of the certificate via Teach Louisiana at by clicking "Verify Teaching Certificate."
NON-PUBLIC TEMPORARY CERTIFICATE APPLICATION FORM
LOUISIANA DEPARTMENT OF EDUCATION
CERTIFICATION, LEADERSHIP, AND PREPARATION
P.O. BOX 94064
BATON ROUGE, LA70804-9044
TOLL FREE #: 1-877-453-2721
please type or print in ink
______Name: First Middle Last/Maiden Married Name
______- ______- ____________/_____/______(_____)______
Social Security Number Date of Birth Phone Number
Email Address: ______
______
Applicant’s Signature Date
Professional Services to be Rendered
School session 20____ - 20____
______Initial Application ______Renewal Application
Name of School:______
Parish Where School is Located: ______
Address of School:______
(Street) (City) (Zip)
Type of Degree(s) Held:______
(Degree) (College/University) (Year)
Subject area(s) to be taught (as listed in Bulletin 746). / Grade LevelHas this teacher previously been employed in this school system? ____ Yes ____ No
If so, has this teacher completed six semester hours required for renewal? ____ Yes ____ No
______
Signature of Employing Authority Date
REQUIREMENTS FOR ISSUANCE OF INITIAL/RENEWAL
OF NON-PUBLIC
TEMPORARY CERTIFICATE
♦ A Non-Public Temporary Certificate, valid for one school year, may be issued for non-public schools and districts that recommend that the candidate be issued this certificate, upon completion of the stipulations listed in these guidelines.
♦ To employ an individual on a Non-Public Temporary Certificate, an employing official must verify that no regularly certified teacher is available for employment.
♦An individual may be issued a Non-Public Temporary Certificate annually, if evidence is presented to the State Department of Education that the individual is pursuing guidelines as specified in Bulletin 741 for Non-Public Schools.
CONDITIONS: / GUIDELINES FOR RENEWAL:♦ Individual who holds a non-education baccalaureate degree from a regionally accredited institution and wants to fulfill non-public school guidelines. / The holder must earn six semester hours of professional coursework annually.
NOTE:Exception to this policy will be considered in the case of serious medical condition or unavailability of required coursework. (see below)
1. Medical Excuse. When serious medical problems of the teacher or immediate family exist, a doctor's statement is required with a letter of assurance from the teacher that the unmet requirements will be completed prior to the beginning of the next school year. This form is available on the Teach Louisiana website under “Certification Applications & Forms” here:
2. Required Courses Not Available. Documentation that necessary coursework was not available must be provided in the form of letters of verification from all universities in the accessible geographic area of the teacher. The university letter must verify that the necessary coursework was not offered.
Note: The employing school district or school should give every applicant for a Non-Public Temporary Certificate a copy of the guidelines at the time of initial application and for each renewal.
DOCUMENTS REQUIRED FOR THE “RENEWAL” OF A TEMPORARY CERTIFICATE:
- Application Form
- Professional Conduct Form
- Official Transcript
LOUISIANA DEPARTMENT OF EDUCATION
CERTIFICATION, LEADERSHIP, AND PREPARATION
PLEASE TYPE OR PRINT IN INK
PROFESSIONAL CONDUCT FORM(All questions must be answered)
NAME OF APPLICANT: (Including, First, Middle, and Married) / Social Security Number:
______- ______-______
ADDRESS: / DATE OF BIRTH:
Each Question must be answered: / Please Check
YES NO
1. Have you ever had any professional license/certificate denied, suspended, revoked, or voluntarily surrendered?
If YES, in which state?______
2. Are you currently being reviewed or investigated for purposes of such action as stated in #1 or is such action pending?
If YES, in which state?______
3. Have you ever been convicted of any felony offense, beenfound guilty or entered a plea of nolo contendere (no contest), even if adjudication was withheld?
If yes, please provide the following information:
Date of Conviction: ______
State of Conviction: _____ Court Jurisdiction of Conviction: ______
4. Have you ever been convicted of a misdemeanor offense that involves any of the following:
a. Sexual or physical abuse of a minor child or other illegal conduct with a minor child.
b. The possession, use, or distribution of any illegal drug as defined by Louisiana or federal law.
5. Have you ever been granted a pardon for any offense as stated in #3 or #4?
If you answered “YES” to any questions, #1 through #5, you must provide court certified copies of all documents and proceedings, civil records of Federal, State and/or District School Board actions, or other relevant documents that provide full disclosure of the nature and circumstances of EACH separate incident in your application packet.
I affirm and declare that all information given by me in the responses to items #1 through #5 above is true, correct, and complete to the best of my knowledge. I understand that any misrepresentation of facts, by omission or addition, may result in criminal prosecution and/or the denial or revocation of my teaching certificate.
SIGNATURE OF APPLICANT: / DATE: