VERIFICATION OF COMPLETION OF AN APPROVED INSTRUCTIONAL LEADER PROGRAM BY
AN EDUCATOR PREPARATION PROVIDER IN A STATE OTHER THAN TENNESSEE
Please note: ALL DOCUMENTS SUBMITTED TO THE OFFICE OF EDUCATOR LICENSURE AND PREPARATION, AND THE TENNESSEE
ACADEMY FOR SCHOOL LEADERS BECOME THE PROPERTY OF THE TENNESSEE DEPARTMENT OF EDUCATION AND WILL NOT BE
RETURNED TO THE APPLICANT NOR WILL THE DEPARTMENT PROVIDE COPIES OF DOCUMENTS TO THE APPLICANT OR THIRD
PARTIES.
APPLICANT NAME TENNESSEE EDUCATOR LICENSE NUMBER
Please note: Additional requirements or exemptions may apply for specific endorsement areas. Please review State Board
Rule 0520-02-03 and Policy 5.502 for this information.
- Educators must submit this completed form through www.TNCompass.org, as an attachment to
their application for additional endorsement.
- Educ
ators applying for Tennessee instructional leader licensure must provide verification of
completion of an instructional leader program approved for licensure of school principals in a state
other than Tennessee, in addition to the required professional assessments.
Note to recommending agency: By signing below, you are verifying that the above stated individual has met completed an
educator preparation program either approved in a state other than Tennessee (SBE Rule 0520-02-03). In addition, you certify,
to the best of your knowledge, that the individual is at least 18 years of age and possesses good moral character (Tenn.
Code Ann. § 49-5-101).
__________________
_________________________________________
Sta
te Abbreviation
Regional Accrediting Agency
______________________________
________ __________________________
Prog
ram(s) Grade Level
Program Completion Date
______________________________________________________________
______________________________________________________________________
Educator Preparation Provider (Institution/Organization)
______________________________________________________________________
Endorsement Program(s) Completed (Program Title - e.g., biology, elementary)
______________________________________________________________________
Title of Authorized Official (e.g. Director, Dean, or Certification Officer)
Email Address
________________________________________ _________________________
_____________________________________
Name of Authorized Official
Telephone Number
________________________________________ _________________________
_____________________________________
Signature of Authorized Official
Date
Rev. 11/30/20
Note to EPP: Upon completion, please return this form to the applicant for submission to the
o
ffice 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.
