Teacher Standards and Practices Commission
250 Division St. NE Voice (503) 378-3586
alem, OR 97301 Fax (503) 378-4448 www.oregon.gov/tspc
Professional Educational Experience Report (PEER) Form
This form is to be filled out by school district personnel to verify experience for renewals, adding endorsements, or
moving to a new license. Please type or print in ink.
TSPC Account number: _________________ Date of Birth: _____ /____/_________
Month / Day / Year (optional)
Name: ________________ ____________ __________________ _________________
(First) (Middle) (Last) (Maiden or Other)
Position held: Teacher Personnel Services Administrator
If the educator is applying to renew any of the above three categories, fill out all four columns below.
Grade Level
Dates Position Held
From To
No. of Periods or
percentage of FTE
Teachers List subject or special education area(s) or
NCES codes; Administrators or Personnel Services
positions List job title.
Restricted Substitute Experience
You must verify the total number of FTE school days taught for each school year. For example, “47.5 FTE days” for
“School Year: 15–16.” At this time, you do not need to submit this form for other substitute teachers.
School Year ____-____
School Year____-____
School Year ____-____
Total FTE days per year
Professional Development Units (PDUs)
Oregon Administrative Rule requires that all educators must complete professional development units (PDUs).
Full three-year licenses must complete 75 PDUs.
Full five-year licenses must complete 125 PDUs.
For more information regarding PDUs, please visit our website: www.oregon.gov/tspc
I hereby certify that this educator successfully completed the PDUs required for renewal.
YES Amount of PDUs completed___________ NO Not applicable
Signature of Superintendent or Authorized Designee
You may choose to send this form electronically or print the form and sign it manually. If you choose electronic submission,
type the name of the school district’s authorized representative into the signature line. If the form is being signed to verify
experience as a superintendent, the form must be signed by an authorized representative of the school board.
Signature School District City and State Date
HR personnel completing the form: _______________________ Contact phone number: _________________
Submit electronically OR return this form to the educator in a sealed envelope OR mail directly to TSPC in a sealed envelope.
Data Classification Level: 1 Published 11/22/16 Version SL
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