Fillable Application for Alabama Certification Through the State-Approved Educator (University of West Alabama)

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Application for Alabama Certification Through the State-Approved Educator (University of West Alabama)

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Name: _________________________________ This section must be completed by the Alabama college/university.
SSN: ________
-_____-________ Institution Code: ___ ___ ___ - ___ ___ ___ ___
Form NAL 09/2021 Page 1 of 4
Alabama State Department of Education
Educator Certification Section
5215 Gordon Persons Building
Post Office Box 302101
Montgomery, AL 36130-2101
T
elephone: (334) 694-4557
The Alabama State Board of Education and the Alabama State Department of Education do not discriminate on the basis of race, color, disability, sex,
religion, national origin, or age in their programs, activities, or employment and provide equal access to the Boy Scouts and other designated youth
groups. The following person is responsible for handling inquiries regarding the non-discrimination policies: Title IX Coordinator, Alabama State
Department of Education, P.O. Box 302101, Montgomery, AL 36130-2101, email: pss@alsde.edu
.
Application for Alabama Certification Through the
State-Approved Educator Preparation Program Approach
Application and Summary of Requirements
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Name: _________________________________ SSN: ________-_____-________
Form NAL 09/2021 Page 2 of 4
TYPE OR USE BLACK INK WHEN COMPLETING THIS FORM.
PERSONAL DATA (To be completed by the applicant. *REQUIRED FIELDS):
Title (e.g., Mr.)
*Middle
Maiden
*Last
Suffix
*Street/Apt./P.O. Box/Route and Box
*City
*State
*ZIP Code
*Cell Telephone
Home Telephone
Work Telephone
( )
( )
( )
*Social Security Number
ALSDE ID
*Date of Birth (mm-dd-yyyy)
*E-mail Address
FOR STATISTICAL PURPOSES ONLY
Gender (choose one)
(F) Female
(M) Male
Ethnic Origin (choose one)
(01) Hispanic Latino
(02) Not Hispanic Latino
Race (choose one or more, regardless of
Ethnicity)
(01) White
(02) Black or African American
(04) American Indian or Alaska Native
(05) Asian
(08) Native Hawaiian or Other Pacific Islander
SPOUSE OF OR ACTIVE-DUTY MILITARY PERSONNEL
(Per Alabama Act No. 2012-533). This section is to be completed for spouses of active-duty military personnel or active-duty
military personnel who would like to request an expedited review of the certification application packet.
I understand that this request to review my file on an expedited basis does not exclude me from meeting ANY Alabama
teacher certification requirements, including testing.
PROFESSIONAL STATUS AND CRIMINAL HISTORY INFORMATION
Check “yes” or “no” for each question below. “YES” responses require an attached explanation and any additional supporting documentation (e.g.,
court certified copies of judgment, conviction, and sentencing).
READ CAREFULLY (*REQUIRED FIELDS)
Yes No * Have you ever had any adverse action (e.g. warning, reprimand, suspension, revocation, denial,
voluntary surrender) taken against a professional certificate, license or permit issued by an agency other
than the Alabama State Department of Education?
Yes No * Are you currently the subject of an investigation involving a violation of a profession’s laws, rules,
standards or Code of Ethics by an agency other than the Alabama State Department of Education?
Yes No * Are you currently the subject of an investigation involving sexual misconduct or physical harm to a
child?
Yes No * Have you ever resigned from a position rather than face disciplinary action?
Yes No * Have you ever been convicted of, or entered a plea of no contest to a felony or misdemeanor other
than a minor traffic violation?
Yes No * Are you the subject of a pending investigation involving a criminal act?
Yes No
I am married to and living with an active-duty member of the United States Armed Forces who has
been relocated and stationed in Alabama under official military orders
OR
Yes No
I am an active-duty member of the United States Armed Forces who has been relocated and stationed
in Alabama under official military orders.
Name: _________________________________ SSN: ________-_____-________
Form NAL 09/2021 Page 3 of 4
RECORD OF EDUCATION
Name of College/University
Location
Dates Attended
Degree and Major
EDUCATIONAL EXPERIENCE
(Do not include student teaching, substitute, or teacher aide experience. If none, enter none. List recent experience first.)
Dates
Name and Location of School/School System
Grade(s) And Subject(s) Taught Or
Instructional Support Positions
(e.g., counselor, principal) Held
Beginning
(MM/YY)
Ending
(MM/YY)
GENERAL INFORMATION
Application for the Professional Educator Certificate or Professional Leadership Certificate is made by the applicant, in
conjunction with the Alabama college/university, upon completion of all requirements of the State-approved educator
preparation program.
APPLICATION PACKET CHECKLIST
APPLICATION FORMS AND SUPPORTING DOCUMENTS ARE NOT ACCEPTED BY FAX OR E-MAIL. An
application packet must include the items listed below:
Supplement CIT with supporting documentation verifying United States citizenship or lawful presence in the United States.
Form NAL Application for Alabama Certification Through the State-Approved Educator Preparation Program Approach.
A $30.00 nonrefundable application fee. Each additional certificate for which an applicant is determined to be eligible will
require a $30.00 nonrefundable fee for issuance. Neither personal checks nor cash will be accepted.
o The cashier’s check, money order, or copy of the receipt verifying the confirmation number for the online payment
must accompany the application.
NOTE: The above documents (Supplement CIT, Form NAL, and fee verification) are to be forwarded by the applicant to
the Certification Officer of the school/college/division of education at the Alabama college/university where the State-
approved educator preparation program is being completed or was completed. The Certification Officer will attach a
completed Supplement NA1 Recommendation for Certification by the Alabama College/University and other documentation
(official transcripts, State Board of Education approved checklist(s), verification of experience on Supplement EXP, etc.) to
support the recommendation for certification. The complete application packet will then be forwarded by the Certification
Officer to the Educator Certification Section of the Alabama State Department of Education (ALSDE).
BACKGROUND CLEARANCE
Background clearance is based on a fingerprint review.
o Applicants may verify whether their Alabama State Bureau of Investigation (ASBI) and Federal Bureau of
Investigation (FBI) criminal history background checks have been completed and whether they are suitable and fit to
teach under state law at https://tcert.alsde.edu/Portal
.
o Applicants for initial certification, additional certification, and certificate renewal who have not been cleared by
both the ASBI and FBI through the Educator Certification Section of the ALSDE are required to be fingerprinted for
a criminal history background check through the ASBI and FBI.
o Instructions regarding the fingerprint process are available through Gemalto Cogent at
https://www.aps.gemalto.com/al/index_adeNew.htm
or by calling (866) 989-9316.
o The fee must be paid by cashier’s check or money order made payable to the Alabama State Department of Education
or through the Alabama State Department of Education Educator Certification Online Payment System, with a major
credit card, at www.alabamainteractive.org/education (a $4.00 transaction fee will be applied).
Name: _________________________________ SSN: ________-_____-________
Form NAL 09/2021 Page 4 of 4
TEST REQUIREMENTS
For certification through the Alabama State-Approved Educator Preparation Program Approach, applicants must meet all
requirements of the Alabama Educator Certification Assessment Program (AECAP) in effect on the date the application is
received in the Educator Certification Section. The applicant should consult with the Certification Officer of the
school/college/division of education at the Alabama college/university where the State-approved educator preparation
program is being completed or was completed for information on the specific testing requirements which she/he must meet.
Information about the AECAP may also be found on the ALSDE web site www.alabamaachieves.org (click Teachers &
Administrators Teacher Center Teacher Assessment) or by contacting the Educator Assessment Section of the ALSDE
at (334) 694-4594 or
edassessment2@alsde.edu.
ONLY current AECAP- prescribed assessments are accepted.
Only official score reports, submitted with the applicant’s complete and correct Social Security number directly from the
testing company via electronic submission to the ALSDE, will be accepted. The applicant’s failure to provide his/her
complete and correct Social Security number to the testing company will delay the certification process.
Education Testing Service (ETS) automatically forwards official Praxis score reports to the ALSDE if the Alabama
prescribed test is taken in Alabama and the applicant’s complete and correct Social Security number is included. For
Alabama prescribed tests taken outside Alabama, the code 7020 must be used to designate the ALSDE as a recipient of
official score reports.
DO NOT SEND PAPER TEST SCORE REPORTS.
EDUCATIONAL EXPERIENCE
Verification of professional educational work experience is required for issuance of certain advanced level (Class A, Class
AA) Professional Educator or Professional Leadership Certificate(s). The experience must be verified on Supplement EXP.
The Certification Officer of the recommending college/university can advise the applicant if verification of experience must
be submitted to the Educator Certification Section of the ALSDE.
APPLICATION SUBMISSION and ATTESTATIONS
I understand the Educator Certification Section is unable to determine eligibility for Alabama certification until all required
application components have been received and reviewed. Additional information may be requested upon review of the file.
The submission of supporting documents ONLY (e.g., Supplement CIT) does not constitute making application for
certification. Incomplete forms will delay the review of the file.
I understand that I must meet all Alabama certification requirements in effect on the date the application is received in the
Educator Certification Section. Since certification requirements are subject to change, current requirements may be viewed
at www.alabamaachieves.org
.
I understand that I must thoroughly read all requirements of this approach (Form NAL 09/2021).
I give my permission for the recommending Alabama college/university to forward any credential(s) required to support this
certification request.
I understand that it is my responsibility to keep all personal data on file in the Educator Certification Section current.
I understand that it is my responsibility to maintain my certificate and to stay informed of current regulations for renewal.
I certify that all information pertaining to this application form is true and correct and failure to submit accurate information
may result in revocation or non-issuance of my certificate.
By affixing my signature to this document, I am certifying that true and correct information is being provided.
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Application for Alabama Certification Through the State-Approved Educator (University of West Alabama)

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Completed 23 April 2022

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