The purpose of this form is to request an initial teacher or school service provider credential for the individual indicated below.
- Provide all information as required on the form. Incomplete forms shall not be accepted for processing.
- This form must be signed by the hiring or employment verification official of the employing LEA.
- Once completed, this form may be given to the employee so that he/she can add it to their application packet or email to [email protected].
Related Content: Educator Credentialing and Certification