1050 First St. NE, Fifth Floor, Washington, DC 20002 • Phone: (202) 727-6436 TTY: 711 • osse.dc.gov
PROGRAM COMPLETION VERIFICATION FORM FOR
EDUCATOR PROGRAM PROVIDERS (EPP) OUTSIDE OF THE DISTRICT OF COLUMBIA
The purpose of this form is to verify that the applicant listed below has completed a state-approved educator credentialing
program at your institution. Section I is completed by the applicant. Section II is completed by the EPP certification officer. Upon
completion of this form by the certification officer, this form is to be returned to the applicant to be submitted along with other
required documents needed to apply for a DC educator credential.
Section I. Applicant Information
Phone:
Name of EPP/Institution
where program was completed:
Section II. EPP Certification Officer Verification and Information
Name of program subject area Grades covered by program Date completed
1
2
Program type completed:
Bachelor’s Master’s Graduate Certificate
Specialist Doctorate Licensure Only (non-degree)
Pathway route type: Traditional Non-traditional Other:
Describe the type of field
experience(s) completed.
This individual has successfully completed all requirements of our approved educator credentialing program which leads to
state certification in the subject area(s) indicated.
This individual DID NOT successfully complete all requirements of our approved educator credentialing program, for the
reason(s) checked below.
Did not successfully complete all student teaching, practicum, internship and/or experience requirements.
Did not successfully pass all program required test(s).
Phone
EPP Certification Officer Printed Name
_
_______________________________________________________________________________________
EPP Certification Officer’s Original or Electronic Signature
click to sign
signature
click to edit
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