Emergency Permit - Fee $57
State Board for Educator Certification (SBEC) rules require permit fees to be paid by the requesting
school district.
Office of Educator Certification
TEA-EDCERT 02410-2010 Revised 10/09/2018
Copyright© Texas Education Agency. All Rights Reserved.
Page 1 of 2
The employing school district must maintain this form in the district's personnel office after online processing is completed.
Permit requests for career and technical education assignment must be accompanied by a Statement of Qualifications (form
026) indicating approved work experience required to teach the instructional area for which the permit is activated.
Last Name InitialFirst Name
TEA ID number
If YES, attach a statement with the date and place of arrest, nature of charge, date and court trial, and subsequent disposition.
Applicant's Affidavit - Not for Visually Impaired Permit (all applicants must execute this affidavit)
“I ACCEPT THIS ASSIGNMENT AND CONSENT TO THE ACTIVATION OF THIS PERMIT.
“I understand that this permit may not be renewed.
“I do hereby agree, consent and direct that any person or entity maintaining information in any form relating to my criminal
history shall release all such information upon the request of the Texas Education Agency.
“I do further hereby agree and permit the Texas Education Agency to obtain from any person or entity information relating
to my personal background, my moral character and my worthiness to instruct the youth of this state, and do hereby
expressly direct that any such person or entity release such information upon the request of the Texas Education Agency.”
“I do hereby release, discharge, and exonerate the Texas Education Agency, it agents or representatives, and any person or
entity so furnishing information from any kind and all liability of every kind arising therefrom.”
“The foregoing consent and release is valid and binding so long as I hold or seek my certification, license, permit or other
credential issued under the authority of the Texas Education Code.”
“I understand that any credential issued to me by the Texas Education Agency is the property of the State of Texas. I agree
that I will tender my credential to the Texas Education Agency if I am ordered to do so by the Texas Education Agency.”
“I understand that a copy of this affidavit shall have the same force as the original.”
“I have reviewed this application and I affirm that all of the information which I have provided on the application and the
attached documents is true.”
Date
Drivers License/State ID Number
Applicant's Signature
Yes
No
Have you ever been the subject of an arrest that has resulted in deferred
adjudication, probation or conviction?
If YES, attach a statement providing the school district, state, and detailed information.
Yes
No
Have you ever had a teaching certificate revoked, denied, suspended or
subject to any sanctions in Texas or any other state?
Emergency Permit - Fee $57
State Board for Educator Certification (SBEC) rules require permit fees to be paid by the requesting
school district.
Office of Educator Certification
TEA-EDCERT 02410-2010 Revised 10/09/2018
Copyright© Texas Education Agency. All Rights Reserved.
Page 2 of 2
Date of Deficiency Plan
Information to be completed by the employing school district
County/District Number
Beginning date of teaching duties for this permit assignment
Assignment Data: Rules relating to permits may be found in the Texas Administrative Code, Chapter 230, Subchapter F
Description of Assignment
Grades
Low
Grades
High
Semester Hours
Complete in
Subject taught
Years of Teaching
Experience
Meets Permit
Qualifications
(Yes or No)
Certification Plan (Select only one)
Certified individuals registered for the next administration of the appropriate certification examination(s)
Deficiency Plan from an approved Texas educator preparation program.
Semester hours deficient
Emergency Permit - Superintendent's Statement
Name of Superintendent or Authorized Representative
Date
Signature of Superintendent or Authorized Representative
"I have been unable to secure the service of an individual certified/qualified for the assignment indicated above. The applicant named in
this permit application is the best qualified person and has agreed to accept the assignment(s) indicated. I have explained and placed in
writing to the applicant the requirements for renewal of this permit. All qualifications of the applicant and statements made on the
application are true and correct to the best of my knowledge."
GPA Sufficient