Wisconsin Department of Public Instruction
SUBSTITUTE TEACHER TRAINING VERIFICATION
PI-1633 (New 07-18)
Telephone: 608-266-1028
or
800-266-1027
Website: http://dpi.wi.gov/tepdl
This forms is available at: http://dpi.wi.gov/tepdl/elo/supplementary-forms
Instructions for the Applicant: Complete Section I below. Have the school district, CESA, EPP, or DPI-approved substitute teacher training provider
complete the Section II and Section III of the form with signature.
Instructions for Substitute Teacher Training Provider: Complete Section II and Section III below, sign, and return to applicant.
SECTION I
APPLICANT INFORMATION
Legal Name Last, First, Middle
Social Security Number* Last 4 Digits Only
Other / Previous Names
SECTION II
SUBSTITUTE TEACHER VERIFICATION
The applicant listed above in Section I has completed all the following requirements, listed below, for Substitute Teacher Training:
• Basic school district and school policies and procedures.
• Age-appropriate teaching strategies.
• Discipline, conflict resolution, and classroom management techniques.
• Health and safety issues, including handling medical emergencies.
• Techniques for starting a class.
• The culture of schools and the teaching profession.
• Working with lesson plans.
• Working with children with disabilities, including confidentiality issues.
Completion Date of Substitute Teacher Training
SECTION III
SUBSTITUTE TEACHER TRAINING PROVIDER INFORMATION
School District / CESA/EPP / DPI-Approved Substitute Teacher Training Provider
Name of Authorized Signer (Printed) First and Last Name
Email Address of Authorized Signer
SIGNATURE
I ATTEST that the educator listed above has completed all requirements of the substitute teacher training.
Signature of Authorized Signer
Date Signed Mo./Day/Yr.
*Collection of social security number is a requirement of s.118.19(1m) and 1(r). It is used solely for validation purposes and will not be released
without written permission.
