!
!
!
!
!
!
!
Complete!the!application!by!checking!the!appropriate!box(es).!!Be!sure!to!sign!and!date!the!application.!!!!
!
Attach!copies!of!ALL!TEACHING!CERTIFICATES!(current!and/or!expired).!
!
Attach!a!current!and!complete!WSU!Unofficial!or!Pipeline!copy!of!your!transcript.!!DO!NOT!REQUEST!THAT!OFFICIAL!OR! UNOFFICIAL!WSU!TRANSCRIPTS!BE!SENT!BY!THE!RECORDS!OFFICE!TO!THE!TEACHER!CERTIFICATION!OFFICE;!THIS!MAY! DELAY!THE!PROCESSING!OF!YOUR!APPLICATION.!
!
Professional!and!Occupational!Education!Certificates! !
Requirements!for!the!Professional!Education!Certificate:!!! !
You!must!have!completed!eighteen!semester!hours!in!a!planned!program!since!the!issuance!of!the!Initial!Provisional! Certificate!OR!have!completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or!support!services!(at!any! time).!You!must!have!completed!three!years!of!teaching!in!the!level!and!subjects!for!which!you!are!certified!to!teach.! All!current!requirements!for!courses!in!the!teaching!of!reading!must!be!complete.!(See!Directions!"!Page!3)!
!
Requirements!for!the!Occupational!Certificate:!!! !
If!you!have!both!a!Provisional!Certificate!and!an!Interim!Occupational!Certificate!(IOC)!(formerly!the!Temporary!
Vocational!Authorization!(TVA)):!
Nine!of!the!required!eighteen!semester!hours!in!a!planned!program!must!be!vocational!education!related!OR!you! must!have!completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or!support!services!(at!any!time).! You!must!have!completed!three!years!of!satisfactory!teaching!in!the!level!and!subjects!for!which!you!are!certified!to! teach.!
!
If!you!have!an!Interim!Occupational!Certificate!only:!
You!must!have!completed!nine!credit!hours!which!are!vocational!education!related.!You!must!have!completed!three! years!of!satisfactory!teaching!in!the!level!and!subjects!for!which!you!are!certified!to!teach.!!!!!
!
Transcripts:!! !
Attach!unofficial!transcripts!from!the!institution!that!recommended!you!for!the!Initial!Provisional!Certificate.!These! transcripts!are!used!to!verify!that!required!courses!in!the!teaching!of!reading!are!complete.!If!credit!from!another! institution!is!being!used!to!fulfill!requirements!for!the!Professional!and/or!Occupational!Certificate!(courses!taken! after!the!issuance!of!the!Initial!Provisional!Teaching!Certificate),!official!transcripts!from!that!institution!MUST!be!sent! directly!to!the!Certification!Office!(see!address!on!Application!"!Page!1).!!As!a!general!rule,!more!than!half!of!the!credit! hours!used!for!the!Professional!or!Occupational!Education!Certificate!must!be!completed!at!Wayne!State!University.!
!
Work!Experience:!!
!
Provide!name!and!address!of!all!school!districts!where!you!have!worked!since!the!issuance!of!the!Initial!Provisional! and/or!Interim!Occupational!Teaching!Certificate.! !The!school!district(s)!will!be!contacted!to!verify!your!satisfactory! work!experience.!
!
Application for Professional/Occupational, Renewal, Endorsement — Directions Page 1
Certification!Office Wayne!State!University!
469!Education! Detroit,!Michigan!!48202!
(313)!577"1788! (313)!577"!4944!FAX
!
Professional
!
Education
!
Certificate
!!
!
Occupational
!
Education
!
Certificate
!
!
Renewal
!
of
!
the
!
Provisional
!
Teaching
!
Certificate
!
!
Renewal
!
of
!
the
!
Interim
!
Occupational
!
Certificate
!!
!
Additional
!
Endorsements
!
!
Application
!
procedures
!
for:
Renewal!of!the!Provisional!or!Interim!Occupational!Certificate!
!
If!requirements!for!the!Professional!or!Occupational!Education!Certificate!have!not!been!met,!you!may!wish!to!apply!
for!a!renewal!of!your!Provisional!or!Interim!Occupation!Certificate.!
!
Requirements!for!the!First!Renewal!of!the!Provisional!Certificate:!
!
You!must!have!completed!nine!(of!the!required!eighteen)!semester!hours!in!a!planned!program!since!the!issuance!of! the!Initial!Provisional!Certificate!OR!have!completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or! support!services!(at!any!time).!
!
Requirements!for!the!Second!Renewal!of!the!Provisional!Certificate:!
!
You!must!have!completed!eighteen!semester!hours!in!a!planned!program!since!the!issuance!of!the!Initial!Provisional! Certificate!OR!have!completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or!support!services!(at!any! time).!All!current!requirements!for!courses!in!the!teaching!of!reading!will!be!reviewed!for!completeness.!(See! Directions!"!Page!3)!
!
Requirements!for!the!First!Renewal!of!the!Interim!Occupational!Certificate:!
!
You!must!have!completed!nine!semester!hours!in!a!planned!program!since!the!issuance!of!the!Interim!Occupational! Certificate!(If!you!have!an!IOC,!only!these!semester!hours!must!be!vocational!education!related.)!OR,!you!may!have! completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or!support!services!(at!any!time).!
!
Requirements!for!the!Second!Renewal!of!the!Interim!Occupational!Certificate:!
!
You!must!have!both!a!Provisional!and!an!Interim!Occupational!Certificate.!A!Second!Renewal!of!the!Interim! Occupational!Certificate!is!not!available!if!you!have!the!Interim!Occupational!Certificate!only.!You!must!have! completed!eighteen!semester!hours!in!a!planned!program!since!the!issuance!of!the!Interim!Occupation!Certificate!OR! have!completed!a!Master’s!Degree!in!an!area!appropriate!to!K"12!education!or!support!services!(at!any!time).!
!
Transcripts:!!
!
If!credit!from!another!institution!is!being!used!to!fulfill!requirements!for!a!first!or!second!renewal!of!the!Provisional! Certificate!(courses!taken!after!the!issuance!of!the!Initial!Provisional!Teaching!Certificate),!official!transcripts!from!that! institution!MUST!be!sent!directly!to!the!Certification!Office!(see!address!on!Application!"!Page!1).!!As!a!general!rule,! more!than!half!of!the!credit!hours!used!for!the!renewal!must!be!completed!at!Wayne!State!University.!!
!
Endorsements:!
!
Provide!a!copy!of!the!signed!Plan!of!Work!for!the!endorsement.!!If!changes!to!the!Plan!of!Work!were!approved!by!your! advisor,!you!must!provide!a!copy!of!these!changes.!
!
Guidance!and!Counseling!Endorsement!
!
Contact!the!Counselor!Education!Department!at!(313)!577"1613!to!submit!the!“Application!for!Recommendation!for! School!Counselor!Credential”!form.!This!form!must!be!approved!by!the!program!advisor!and!submitted!to!the! Certification!Office!for!inclusion!in!your!application.!
!
Library!Media!Endorsement!
!
Contact!the!Library!&!Information!Science!Program!at!(313)!577"1825!to!request!a!“Letter!of!Completion”!stating!that! you!have!met!the!course!requirements!for!the!Library!Media!endorsement.!
!
Provide!a!copy!of!the!Michigan!Test!for!Teacher!Certification!(MTTC)!for!the!endorsement!if!applicable.!Some! endorsements!require!other!verification!of!experience!or!competencies!(this!is!reflected!on!your!Plan!of!Work).!!Ask! your!advisor!if!you!have!questions!about!endorsement!requirements.!!
!
Note:!MTTC!Subject!examination!scores!are!valid!for!five!years.! ! !
!
Transcripts:!
!
If!credit!from!another!institution!is!being!used!to!fulfill!requirements!for!the!endorsement!(credit!which!does!not! appear!on!the!WSU!transcript),!official!transcripts!from!that!institution!MUST!be!sent!directly!to!the!Certification! Office!(see!address!on!Application"Page!1).! !As!a!general!rule,!more!than!half!of!the!credit!hours!used!for!the! endorsement!must!be!completed!at!Wayne!State!University.!!
!
For!all!applications:!
!
Application!review!will!commence!when!all!required!materials!have!been!received.!
!
If!your!name!has!changed,!please!contact!the!WSU!Records!Office!at!(313)!577"!3531!to!change!your!name.!
!
*Required!courses!in!the!teaching!of!reading!
!
The!Michigan!Department!of!Education!requires!that!the!recipient!of!any!Professional!Education!Certificate!must!have! completed!the!current!requirements!for!the!teaching!of!reading.!Teachers!with!elementary!teaching!certificates!must! have!completed!at!least!six!semester!hours;!teachers!with!secondary!teaching!certificates!must!have!completed!at! least!three!semester!hours.!At!Wayne!State!University,!this!is!interpreted!to!mean!that!all!recipients!of!the! Professional!Education!Certificate!must!have!completed!RLL!4430,!Teaching!Reading!II:!Comprehension!Preprimary"8! or!RLL!6120,!Developmental!Reading!I:!Comprehension!Preprimary"8!for!elementary;!RLL!4431,!Teaching!Reading!in! Middle!and!Secondary!Subject!Areas!or!RLL!6121,!Teaching!Reading!in!the!Content!Areas:!Grades!6"12!for!secondary! (or!equivalents).!The!additional!three!semester!hours!required!for!the!!elementary!certified!teacher!may!be!one!of!the! following:!!
ELE!3320,!Teaching!Reading!I:!Emergent!Literacy! ! ELE!6310,!Reading!Instruction:!Preprimary"9!
ELE!6320,!Reading!Curriculum:!Preprimary"9!! ! ELE!6340,!Teaching!Reading!in!Early!Childhood!Education! RLL!7100,!Emergent!Literacy! ! ! ! RLL!7300,!Literacy!Across!the!Curriculum!
!
Beginning!July!1,!2009!all!candidates!for!the!Professional!Education!Certificate!must!have!completed!a!three!semester! hour!course!in!the!diagnosis!and!remediation!of!reading!disabilities!and!differentiated!instruction.!At!Wayne!State! University!the!courses!which!meet!this!requirement!are!RLL!6801,!Assessment!and!Differentiated!Instruction!for! Diverse!Learners!Pre"K"8!for!elementary!and!RLL!6802!Assessment!and!Differentiated!Instruction!for!Diverse!Learners! 6"12!for!secondary.!!!!!!!
!
Processing!Timeline!
!
! A!preliminary!audit!of!your!application!will!commence!after!all!necessary!documents!have!been!received.!If!you! are!enrolled!in!classes!during!the!semester!during!which!you!plan!to!complete!requirements,!a!FINAL!AUDIT!will! be!completed!AFTER!ALL!grades!have!been!posted.!
!
! Processing!is!typically!completed!within!two!weeks!after!receipt!of!all!documentation.! !
! You!will!receive!a!temporary!certification!letter!(90"Day!Letter)!stating!the!level!and!area!of!certification!for!which! you!will!be!recommended!to!the!Michigan!Department!of!Education!(MDE).!This!letter!can!be!used!for! employment!purposes!as!verification!that!all!requirements!for!the!teaching!certificate!or!endorsement!have!been! met.!Within!the!validity!of!this!letter,!WSU!will!send!a!recommendation!to!MDE!for!your!certificate!and!MDE!will! send!a!request!for!the!requisite!fee!(see!below).!Once!the!fee!has!been!paid,!MDE!will!mail!your!teaching! certificate!to!you.!
!
Certification!Fees!–!Subject!to!Change! !
Type!of!Certificate! ! ! ! ! !!!!!!!!!! !!!!!!!!!Required!Fee!
!
Professional!Education!Teaching!Certificate! ! ! ! $160.00!
! !
Occupational!Education!Teaching!Certificate! ! ! ! $160.00!
! !
Professional!Education!Teaching!Certificate! ! ! ! $160.00!
! !
Renewal!of!Provisional!or!Interim!Occupational!Certificate! ! $100.00!
! !
Professional!Education!Teaching!Certificate! ! ! ! $160.00!
! !
Additional!Endorsement! ! ! ! ! ! $!50.00!
Application for Professional/Occupational, Renewal, Endorsement — Directions Page 3
! ! ! ! !
DO!NOT!ATTACH!FEE! !
You!will!be!billed!by!the!Michigan!
Department!of!Education!upon!their!
receipt!of!Wayne!State!University’s!
Application for Michigan Professional and/or Occupational
Education Certificate, Renewals, and Endorsements
!
Application for Professional/Occupational, Renewal, Endorsement — Application Page 1
Please!check!the!certificate!or!endorsement!for!which!you!are!applying:!
!
Professional!Education!Certificate!
!
Occupational!Education!Certificate! !
Renewal!of!the!Provisional!Certificate! ! ! First!Renewal! ! Second!Renewal! !
Renewal!of!the!Interim!Occupational!Certificate! ! First!Renewal! ! Second!Renewal! !
New!Endorsement:!!Specify!Subject!______________________________________________________!
Level!of!Current!Teaching!Certificate:!Attach!copies!of!all!teaching!certificates,!current!and!expired:!
!
Elementary!!!!!!!!!!!Secondary!
!
Bachelor’s!Degree!Completed!(Institution):!__________________________________!Degree!Date:!!______________!
!
Initial!Provisional!Certificate!Recommended!(Institution):!_____________________________Date:!_______________!
!
Master’s!Degree!Completed!(Institution):!!__________________________________!Degree!Date:!!_______________!
!
Other!Advanced!Degree!Completed!(Institution):!!____________________________!Degree!Date:!!_______________!
Official!Transcripts!are!required!if!courses!completed!at!other!institutions!are!being!used!to!fulfill!requirements!for!
this!certificate!or!endorsement.!Do!not!request!Official!Wayne!State!University!transcripts.!Provide!a!“Pipeline”!
transcript!or!a!copy!of!your!unofficial!WSU!transcript.!
!
I!have!requested!official!transcripts!from!the!following!institution(s)!be!sent!directly!to!the!Teacher!Certification! Office:______________________________________________________________________________________!
Certification!Office Wayne!State!University!
469!Education! Detroit,!Michigan!!48202!
(313)!577"1788! (313)!577"!4944!FAX
Please
!
!
or
!
type
!
your
!
name
!
as
!
you
!
want
!
it
!
to
!
appear
!
on
!
your
!
certificate:
!
!
Name:!____________________________!!!_____________________!!_________________!!____________________!
! ! !!!!!!!!!Last! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!First!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Middle! !!!!!!!!!!!!!!!!!!!!!!!!Maiden! !
Note:!If!your!name!has!changed,!please!contact!the!Wayne!State!University!Records!Office!
!(313)!577"3531!to!change!your!name!or!attach!documentation!reflecting!name!change.!
!
Home!Address:!____________!!!______________________!!!________________________!!!______!!!____________!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Number! ! !!!!!!!Street! ! !! !!!!City! ! !!!!!!!!!!State!!!!!!!!!Zip!Code! !
Telephone!Number:!_______!"!_______!"!_________!!!Birthdate:______!/!______!/!______!!!Gender:!!! !!!!!Male! ! !!!!!!!!!!!!!!!!!!!(Area!Code)! ! ! ! ! ! ! ! ! !!!!!!!!!!!!!!!!!!!!Female! !
E"mail!Address:!______________________________!!Wayne!State!University!I.D.!#:__________________________!!!! !
Social!Security!Number:!__________!"!________!"!____________!
The!Social!Security!number!is!required!by!the!
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Application for Professional/Occupational, Renewal, Endorsement — Application Page 2
Complete
!
this
!
section
!
only
!
if
!
you
!
are
!
applying
!
for
!
the
!
Professional
!
Teaching
!
Certificate.
!
Provide
!
employers
!
for
!
teaching
!
experience
!
since
!
the
!
issuance
!
of
!
the
!
Initial
!
Provisional
!
Teaching
!
Certificate.
!
!
Name!of!School!and!District:!_______________________________________________________________________!
!
Address:!____________!!!___________________________!!!_________________________!!!______!!!____________!!
!!!!!!!!!!!!!!!!!!!!!!!Number! ! !!!!!!!!!!!!Street! ! !! !!!!!!!!!!!!!!!City! ! !!!!!!!!!!State!!!!!!!!!Zip!Code!
!
Telephone!Number:!_______!"!_______!"!_________!!!!!!!!!!!Dates:!!!!!__________________!!!!!!___________________! ! !!!!!!!!!!!!!!!!!!!!!(Area!Code)!! ! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!From!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!To!
! ! ! ! ! ! ! !
Type!of!Employment:! Substitute! ! Contract!
! !
Name!of!School!and!District:!_______________________________________________________________________!
!
Address:!____________!!!___________________________!!!_________________________!!!______!!!____________!!
!!!!!!!!!!!!!!!!!!!!!!!Number! ! !!!!!!!!!!!!Street! ! !! !!!!!!!!!!!!!!!City! ! !!!!!!!!!!State!!!!!!!!!Zip!Code!
!
Telephone!Number:!_______!"!_______!"!_________!!!!!!!!!!!Dates:!!!!!__________________!!!!!!___________________! ! !!!!!!!!!!!!!!!!!!!!!(Area!Code)!! ! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!From!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!To!
! ! ! ! ! ! ! !
Type!of!Employment:! Substitute! ! Contract!
! !
Name!of!School!and!District:!_______________________________________________________________________!
!
Address:!____________!!!___________________________!!!_________________________!!!______!!!____________!!
!!!!!!!!!!!!!!!!!!!!!!!Number! ! !!!!!!!!!!!!Street! ! !! !!!!!!!!!!!!!!!City! ! !!!!!!!!!!State!!!!!!!!!Zip!Code!
!
Telephone!Number:!_______!"!_______!"!_________!!!!!!!!!!!Dates:!!!!!__________________!!!!!!___________________! ! !!!!!!!!!!!!!!!!!!!!!(Area!Code)!! ! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!From!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!To!
! ! ! ! ! ! ! !
Type!of!Employment:! Substitute! ! Contract!
Conviction
!
and
!
Revocation
!
Information
!
!
Please!read!the!following!statement!and!answer!the!three!questions!listed!below!(completion!of!this!section!is!
required).!
!
The!Michigan!State!Board!of!Education!may!refuse!to!grant!a!certificate!to!an!applicant!convicted,!as!an!adult,!of!an! act!of!immoral!conduct!contributing!to!the!delinquency!of!a!child,!or!a!felony!conviction.!
!
! 1.! Have!you!ever!been!convicted!of!a!felony?! ! ! yes! ! no!
!
! 2.! Have!you!ever!been!convicted!of!a!misdemeanor?! ! yes! ! no!
!
! 3.! Have!you!ever!had!a!professional!license!or!certification,!!
! ! denied,!suspended!(for!cause)!or!revoked?! ! ! yes! ! no! !
If!you!answer!“yes”!to!any!of!the!questions!regarding!convictions!and!revocations,!attach!a!current!(within!6!months!of!the!
application!date)!Statewide!Criminal!History!Check!from!the!Internet!Criminal!History!Access!Tool!(ICHAT)!website:!http://!
apps.michigan.gov/ICHAT/!and!a!narrative!describing!the!circumstances!surrounding!the!conviction!or!action.!Note:!In!some!
cases!you!may!be!required!to!submit!certified!copies!of!all!documents!relative!to!the!conviction!or!action,!including!the!
Judgment!of!Sentence!from!the!court(s)!in!which!the!matter!was!adjudicated.!!
Please
!
continue
!
on
!
a
!
separate
!
sheet
!
if
!
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
Application for Professional/Occupational, Renewal, Endorsement — Application Page 3!
Race:!Please!identify!your!racial/ethnic!background!(check!one!box!only).!
!
Even!if!you!are!multiracial,!please!select!one!box!by!indicating!either!the!race!you!identify!with!the!most!or!the!
race!with!which!you!are!usually!associated!in!the!community.!
!
American!Indian,!Eskimo,!or!Aleut! ! Asian!or!Pacific!Islander!! ! Black!(non"Hispanic)!
!
Hispanic! ! ! ! ! White!(non"Hispanic)!
!
Are!you!multiracial?!!For!purposes!of!this!question,!you!are!multiracial!if!you!have!parents!from!more!than!one!of!
the!broad!race!categories!listed!above,!or!if!your!parents!regard!themselves!as!being!multiracial.!
!
Yes! ! No!
Acknowledgment!&!Consent!!!
!
I!affirm!that!the!information!provided!in!this!application!is!true,!complete,!and!accurate,!and!I!hereby!grant! permission!for!school!officials!to!release!information!concerning!my!degree!and!certification!to!potential!employers! and!certification!agencies.!
!
Applicant’s!Signature:__________________________________________! Date:________________!
!
Public!Act!339!of!1998!authorizes!collection!of!fees!for!certification!in!Michigan!in!accordance!with!the!fee!schedule.!In!addition,!
the!Administrative!Rules!Governing!Certification!requires!that!an!application!for!certification!must!be!made!no!later!than!five!
years!after!credit!requirements!have!been!met.!Payment!of!the!fee!is!a!certification!requirement!that!must!be!met!prior!to!the!
issuance!of!your!Michigan!certificate.!
"!"!"!"!"!"!"!"!"!"!"!"!"!"!!"!"!"!"!"!"!"!"!DO!NOT!WRITE!BELOW!THIS!LINE!–!FOR!OFFICE!USE!ONLY"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!"!" !! !
Criminal!History!Questions:! OK! Requires!Review— Reviewed!(Date):!________________________!
! ! !
Professional/Occupational!or!Renewal! Master’s!Degree! !
!
Hours!or!Master’s!Degree:!________________!hours!OK! Other_______________________________!!!!!
!
Work!Experience!(Professional/Occupational):!! OK!
!
Reading!Requirement!(Second!Renewal!or!Professional):! Three!Credit!Hours!OK!(Secondary)!
!
! ! ! ! ! ! ! ! Six!Credit!Hours!OK!(Elementary)!
!
! ! ! ! ! ! ! ! Three!Additional!Credit!Hours!(required!after!July!1,!2009)
Endorsement!
!
Current!Michigan!Teaching!Certificate!(Required!for!endorsement)!!! Signed!Endorsement!Plan!of!Work!
!
Endorsement!Hours! MTTC!for!Endorsement!!!or! NA:!_______________________________________!
!
Date:!______________!Evaluator!Initials:!______________!
