Application For Permanent Professional Certification 2023-2024 Step 1 of 6 16% TEACHER CERTIFICATION BRANCH APPLICATION FOR PERMANENT PROFESSIONAL CERTIFICATION 2023-2024 (Authorized by the Minister pursuant to the Education Act, the Certification of Teachers and Teacher Leaders Regulation Alberta Regulation 123/2022 APPLICANT: If in the course of this school year, you will be completing the equivalent of two full school years of teaching, while holding a valid interim professional certificate, you must apply for an evaluation for permanent certification. APPLICANT’S PERSONAL INFORMATION Title(Required)MrMrsMsCurrent Full Legal Name:(Required) First Last FILE/CERTIFICATE NO.(Required) From Alberta EducationList all other (previous) legal names: NOTE: For both evidence of legal name change and of immigration/citizenship status you may choose to submit an unaltered copy of your original document(s) accompanied by a Statutory Declaration form(s) obtained from Alberta Education, Teacher Certification Branch, web site: https://education.alberta.ca/ or by calling 780-427-2045 or toll free by dialing 310-0000. Provide acceptable evidence of name changes. Photocopies of government issued birth certificate, marriage certificate, or legal name change certificate. Do not send original birth or marriage certificates to AISCA. Send copies to Alberta Education, Teacher Certification Branch. These documents can be uploaded to Alberta Education by logging into your TWINS Teacher Self Service account at. https://extranet.education.alberta.ca/twins.public/public/Date of Birth(Required) YYYY slash MM slash DD Personal Phone(Required)Work Phone(Required)Personal E-mail(Required) Work E-mail(Required) Citizenship Status:(Required) Canadian citizen by birth Canadian citizen by naturalization (granted) Permanent resident Other Employment Information for Full-Time, Part-Time Employment: Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Authority/Jurisdiction Name of Employment(Required) Number of Days(Required) Country if from International School Description of Teaching Experience. Indicate Assignment: Elementary (grade levels) or secondary (subjects)Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Authority/Jurisdiction Name of Employment Number of Days Country if from International School Description of Teaching Experience. Indicate Assignment: Elementary (grade levels) or secondary (subjects) Employment Information for Substitution Employment Period of Employment:Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Authority/Jurisdiction Name of Employment Number of Days Country if from International School Description of Teaching Experience. Indicate Assignment: Elementary (grade levels) or secondary (subjects)Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Authority/Jurisdiction Name of Employment Number of Days Country if from International School Description of Teaching Experience. Indicate Assignment: Elementary (grade levels) or secondary (subjects)Please provide Letters of Employment from all former employers with your application to AISCA- DSA Program by email [email protected] or by fax (780)469-9880 or by mail to AISCA-DSA Program, 200, 10458 Mayfield road NW, Edmonton, AB T5P 4P4 Which Independent school has contracted you to teach current/next school year?Name of School:(Required) Start Date(Required) MM slash DD slash YYYY End Date(Required) MM slash DD slash YYYY Name of Principal:(Required) Principal Email Address:(Required) Self-Declaration: I declare that I have read and understood the competencies related to Interim Professional Certification as outlined in the Teaching Quality Standard and I hereby attest to possessing such competencies and to my ability to apply them appropriately toward student learning. I also commit to teaching practice and ongoing professional growth in keeping with the competencies and indicators identified in the Teaching Quality Standard. I declare that the particulars that have been furnished on this form are true and complete in all respects and that no relevant information has been withheld. I declare that all documentation that may be submitted by me has not been changed or altered in any way. I understand that a false declaration or willful omission, or submission of altered, tampered, or forged documentation may result in the non-issuance, suspension, or cancellation of my teaching certificate under the Certification of Teacher and Teacher Leaders Regulation.Applicant’s Signature(Required)The personal information collected as part of this application process for teacher certification is collected pursuant to the provisions of the Certification of Teacher and Teacher Leaders Regulation, and section 33 of the Freedom of Information and Protection of Privacy Act (FOIP Act). This information will be used for the purpose of processing your application to determine your eligibility for extension of your interim professional certificate. The personal information will be treated in accordance with the FOIP Act. Questions regarding the collection may be directed to the Director, Teacher Certification Branch, Alberta Education, 44 Capital Boulevard, 10044 - 108 Street, Edmonton, AB, T5J 5E6. Telephone: (780) 427-2045; toll free by dialing 310-0000.CommentsThis field is for validation purposes and should be left unchanged.
