PROOF OF TEAC
HING EXPERIENCE
OUT-OF-STATE OR OKLAHOMA NONPUBLIC SCHOOLS
Teacher Certification
2500 N Lincoln Blvd Ste 212
Oklahoma City OK 73105-4599
Type or use a ball-point pen and press hard to make a clear copy.
TEACHER NUMBER: _______________
CREDENTIALS VERIFIED: __________
eacher's Name: __________________________________________________________________________ Social Security Number: ___________ ________ ___________
Last First Middle Maiden
klahoma school where currently employed: _________________________________ _______________________________________________________________________
County District
his record is for the Oklahoma State Board of Education to evaluate the experience of the person indicated above. In order to evaluate this experience ALL information must b
ompleted. This information will be used for determining salary increments, retirement credit, and/or for teacher certification.
Yes, the school was accredited for the years listed below.
Name of Accrediting Agency: _________________________________
No, the school was NOT accredited for the years listed below.
ERTIFICATION STATUS:
Yes, the teacher held a valid state teaching credential during the years
listed below.*
State: _______ Validity Dates: ___________ through ___________
(Two Letter Code) (MM/DD/YY) (MM/DD/YY)
No, the teacher did NOT hold a valid teaching credential during the years
listed below.
NAME AND ADDRESS OF THE OUT-OF-STATE OR NONPUBLIC SCHOOL
___________________________________________________________________________
Name of School
___________________________________________________________________________
Street Address City State Zip Code
_____________________________________________ ( _______ ) __________________
Print Name and Title of Certifying Official Telephone Number
USE A SEPARATE LINE FOR EACH SCHOOL YEAR AND COMPLETE ALL COLUMNS
*PLEASE INCLUDE A COPY OF YOUR OUT-OF-STATE TEACHING CERTIFICATE THAT WAS VALID DURING THE ABOVE DATES.
Per Oklahoma State Statute Title 70 § 18-114.14, teaching credit ca
n be granted only for out-of-state teaching experience obtained in an accredited school system while the teacher was
certified to teach or who received special approval to teach by the state's licensing authority. For the purpose of state salary increments and retirement, no teacher shall be granted credit for
more than five years of out-of-state teaching experience as a certified teacher.
School District or Institution
(Mo Day Yr)
(Mo Day Yr)
or Fraction
of Day
Employed
Number of
Days
Employed
Days in
Full Year
Signature of Certifying Official
SIGN EACH LINE
Send one copy to School Personnel Records and one copy to Teacher Certification.
July 2018