The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Teaching Initiatives
www.highered.nysed.gov/tcert
Verification of Paid Experience Form for Teachers
New York State employers with access to TEACH would complete a Superintendent Statement in the TEACH Online
System instead of completing this form.
For other employers, this form must be completed and submitted by one of the following individuals:
Superintendent, Superintendent’s designee, Director of Human Resources, Chief School Officer of the approved non-
public/independent school, or in the case of Speech and Language Disabilities or Students with Disabilities experience
only, the authorized official listed for the approved contracting agency.
Instructions
The form must be completed and submitted by the employer and must be sent to the Office of Teaching Initiatives
via email to otiexpverif@nysed.gov. The Office of Teaching Initiatives will not accept the form if it is sent by the
applicant. It is suggested that the employer provide the applicant with a copy of this completed form for his/her
records. Applicants who applied through a BOCES should have a copy of the form sent to their BOCES contact.
If the applicant is/was employed via contract with a public school district as a Speech and Language Disabilities or
Students with Disabilities teacher, the employer must submit a copy of the contract with the public school district in
addition to this form.
The end date of employment must be on or before today’s date; future end dates, "to present", and/or incomplete
forms will not be accepted.
Date of Birth: / / (mm/dd/yyyy)
Last 4 Digits of Social Security Number:
Certificate title(s) for which the applicant is requesting this form be completed:
Enter the total full-time equivalent days worked during each year of employment (12-month period). For the
Professional certificate in the classroom teaching service, individuals must complete at least three years of
acceptable teaching experience or its equivalent (540 full-time days). Full-time and part-time experiences are
acceptable. Hourly employment must be converted to full-time equivalencies.
Employment Year 1: From: / / (mm/dd/yyyy) to: / / (mm/dd/yyyy)
1. Total number of full-time equivalent days worked:
2. I attest that the applicant was a classroom teacher, a substitute teacher, or in another acceptable
paid teaching position during this time period. Please note that teaching assistant and teacher
aide experience is not acceptable. The list of acceptable teaching positions is available at:
www.highered.nysed.gov/tcert/certificate/exp/classroom-professional.html
3. I attest that the applicant held a valid and appropriate teaching certificate for their teaching assignment,
or was not required to be certified for their teaching assignment, during this time period. Information on
when a valid and appropriate teaching certificate is required is available at:
www.highered.nysed.gov/tcert/certificate/exp/classroom-professional.html
