Verification of Accreditation Status for Test
This form will not be returned or forwarded
Revised (5/22/2018)
Copyright© Texas Education Agency. All Rights Reserved.
Last Name
InitialFirst Name
The information requested below is needed to determine whether the experience may be claimed for certification and test exemptions.
Thank you for your assistance in completing this form.
Previous Employment From Previous Employment To
1. Was this school during the years indicated above operated by or under the jurisdiction of a governmental
unit in the state in which this institution is located?
If Yes, please provide the name of the governmental unit.
2. Was this school, during the years indicated above, accredited by a United States accrediting agency recognized
by the U.S. Department of Education or by the state or national government in which this school is located?
If Yes, please provide the name of the accrediting agency or governmental unit.
3. Is this a public or private school?
Signature of authorized official
Title and Name of Authorized Official (print)
4. If the school is operated on the British system please indicate government or
public school.
Name of School
State Zip code
Educator Information -To be completed by the educator as it appears in your TEA educator account (ECOS)
Employment Information - To be completed by the employing school
The organization's official stamp must be included on the form if service from outside of the United States is reported. For public schools, the
country's Department of Education is the organization official stamp.
Please do not return this form to the educator. TEA will not accept forms directly from the educator.
This form may be mailed or emailed using the button below. Please mail to: Texas Education Agency
(If verification is from another country, 1701 North Congress Ave
this form will only be accepted by mail.) WBT 5-100
Austin, TX 78701
Please Print, Sign, Scan, and Submit by Email to service is from another country this form will only be accepted by mail.)