Fillable II Out-of-State Practitioner Teacher or School Services Personnel (State of Tennessee)

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II Out-of-State Practitioner Teacher or School Services Personnel (State of Tennessee)

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The II Out-of-State Practitioner Teacher or School Services Personnel (State of Tennessee) form is 2 pages long and contains:

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  • 34 other fields

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File type: PDF

U.S.A. forms for State of Tennessee

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II
Departmen~ of
- .
Education
•
Out-of-State Practitioner Teacher or School Services Personnel
Candidate Recommendation Form
Section 1. Applicant Information
Last Name:
First Name:
Date of Birth:
Social Security Number:
Primary Phone:
mm/dd/yyyy
999-99-9999 (999) 999-9999
Email Address:
Section 2. Out-of-State Practitioner Teacher or School Services Personnel Recommendation
Indicate License Type:
(pick one)
Practitioner Teacher
Practitioner School Services Personnel (option 2 only)
Select Option 1 or Option 2
Option 1. Candidates enrolled in an out-of-state educator preparation program and completing a job-embedded
clinical practice in Tennessee. Provide verification of enrollment in an approved out of state preparation program that
has a department recognized partnership with a Tennessee school district.
Note to Recommending Agency: By signing below, you are indicating that the above stated individual has completed
an educator preparation program approved in a state other than Tennessee (SBE Rule 0520-02-03). In addition, you
certify that to the best of your knowledge the individual is at least 18 years of age and possesses good moral
character (TCA § 49-5-101).
Educator Preparation Provider: (institution/organization name)
State:
Regional Accrediting
Agency:
Program Grade Span(s):
Program Completion
Preparation Program(s) Completed:
program title/specialty area/endorsement area (e.g., elementary, biology, general music)
Date:
Requested Tennessee Endorsement:
Undergraduate Major:
Partnering School District Name:
Name and Title of Authorized EPP Official:
Email Address:
II
Departmen~ of
- .
Education
•
•
~•
The EPP has verified content knowledge through submission of qualifying scores on required specialty area assessments
(see SBE Policy 5.105 for required assessments and passing scores), and
The candidate has requested that the assessment administrator send the qualifying scores to the Tennessee Department
of Education (SSN must be provided to assessment administrator).
Signature of Authorized EPP Official:
Date:
Primary Phone:
Option 2. Candidates who completed an educator preparation program in a state other than Tennessee. Provide
verification of completion of all requirements for an educator preparation program approved for licensure in a state
other than Tennessee.
Note to Recommending Agency: By signing below, you are indicating that the above stated individual has completed
an educator preparation program approved in a state other than Tennessee (SBE Rule 0520-02-03. In addition,
you certify that to the best of your knowledge the individual is at least 18 years of age and possesses good moral
character (TCA § 49-5-101).
Educator Preparation Provider: (institution/organization)
State:
Regional Accrediting
Agency:
Program Grade Span(s):
Program Completion
Preparation Program(s) Completed:
program title/specialty area/endorsement area (e.g., elementary, biology, general music)
Date:
Name and Title of Authorized EPP
Email Address
Primary Phone:
Official:
Signature of Authorized EPP Official:
Date:
Revised September 2020
Note to EPP: Upon completion, please return this form to the applicant for submission to the
office of educator licensure and preparation.
Note to Applicant: Upon receipt, please upload completed form to the Attachments section on the
Licensure tab of your www.TNCompass.org account.
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II Out-of-State Practitioner Teacher or School Services Personnel (State of Tennessee)

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Completed 23 January 2021

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