School District Teaching Permit
Application
Copyright© Texas Education Agency. All Rights Reserved.
MB Revised (04/21/2011)
Is this person serving on an emergency teaching permit in the state of Texas?
Has this person ever been issued a teaching credential in another state?
Does this person hold a Texas teaching certificate?
Has this person had educator credentials sanctioned or has this person had an application for educator
credentials denied?
Has this person been unable to pass appropriate ExCET and/or TExES exam(s)?
Please attach documentation providing the following information
A completed Verification of Experience form signed [full-time wage earning experience verified by an
authorized certified school administrator.]
Criminal history Report obtained from any law enforcement/criminal justice agency showing nationwide
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Superintendents Affidavit:
This written statement serves notice to the Commissioner of Education that I have identified a person who is qualified to teach in
the above subject(s) and/or classes. I have reviewed this form and I affirm that all of the information, which I have provided, is true.
I attest that the above person will be assigned in compliance with the requirement for approval by a principal under TEC §11.202.
Attached
Attached
Attached
Name of Superintendent/Designee
Superintendent/Designee Signature
Mail completed application form and required documentation to:
Judy M. Okimura, Texas Education Agency, Educator Certification and Standards, 5th floor, 1701 North Congress Ave,
Austin, TX 78701-1494
Section A - Applicant Information
Last Name First Name
Maiden Name (if applicable)
SSN
Date of Birth
Middle Initial
Gender Ethnicity
Section B - District Information
District Name
County/District Number
Please answer the following questions as they apply to the individual for whom this permit is requested.
Official transcripts from regionally accredited university or college showing bachelor's degree conferred
and subject relevant college credits in the subject area to be taught.
Assignment/Subject to be Taught Low Grade High Grade
Date
No Yes
Yes No
Yes No
Yes No
Yes No
Title of Superintendent/Designee
Attached
Copy of industry license(s) or industry certification(s)
Superintendent/Designee Direct Phone
Number
