Verification of Educator Experience for Test
Exemption
This form will not be returned or forwarded
Copyright© Texas Education Agency. All Rights Reserved.
Revised (3/27/2019)
Educator Information -To be completed by the educator
Enter your information as it appears in your TEA educator account (ECOS).
Zip codeState
City
Address
InitialFirst Name
Last Name
Experience Information -To be completed by Human Resources staff from the employing school district
(do not include service for future dates)
Name and location of school
Government
Public
2. If the school is operated under the British system please indicate government or
public school.
1. Is this a public or private school?
Public
Private
Indicate type of school, please select option 1 or 2, not both
State
Country
Year service ended
Year service began
I confirm that the educator has completed at least 1 year (180
days) of full-time wage-earning classroom teaching experience
or 2 years of experience of at least 50% of the day.
Classroom Teaching Experience
Administrative Experience: Assistant Principal, Principal, or Superintendent experience only
(do not include assistant superintendent experience)
I confirm that the educator has completed at least 2 years (180 days per year) of full-time wage-earning
experience, or 4 years of experience of at least 50% of the day in the field or fields indicated below.
Year service
ended
If service is for less than 2 years, please indicate the completed number of total days for each year, below.
Year service
began
Superintendent experience
(do not include assistant
superintendent experience)
Year service
ended
Year service
began
Assistant Principal or
Principal experience
If service is for less than 1 year, please indicate the completed number of days, below.
Verification of Educator Experience for Test
Exemption
This form will not be returned or forwarded
Copyright© Texas Education Agency. All Rights Reserved.
Revised (3/27/2019)
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 do not return this form to the educator. TEA will not accept forms directly from the
educator.
Stamp/Seal
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.
Signature of authorized Human Resources official (required)
Print title and name of authorized Human Resources official (required)
Authorized Signature
Year service
ended
Year service
ended
Year service
began
Year service
began
Reading Specialist
experience
School Librarian
experience
Year service
ended
Year service
ended
Year service
began
Year service
began
Educational
Diagnostician
experience
School Counselor
experience
I confirm that the educator has completed at least 2 years (180 days per year) of full-time wage-earning
experience, or 4 years of experience of at least 50% of the day in the field or fields indicated below.
Student Services Experience: School Counselor, School Librarian, Educational Diagnostician, Reading
Specialist
If service is for less than 2 years, please indicate the completed number of total days for each year, below.
Please Print, Sign, Scan, and Submit by Email to OSC75@tea.texas.gov?(If service is from another country this form will only be accepted by mail.)