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Professional Teaching

Standards Board

Wyoming Standard Educator License

Add Endorsement

Application Packet

This Application Packet is for educators applying to add an endorsement to a current

Wyoming Standard Educator License in the following areas:

Standard Educator License

Administrative (Principal, Director, and Superintendent) Related Services Personnel (School Counselor, School Psychologist, School Social Worker,

Speech-Language Pathologist) Coaching Teachers of Students At-Risk (Alternative/Non-Traditional School/At-Risk Youth Program

or Institutional/Private Residential Facility Teacher)

Submit your complete application packet to: Professional Teaching Standards Board

1920 Thomes Avenue, Suite 100 Cheyenne, WY 82002

- 2 - FORM_GREEN_ENDORSEMENT Updated 05/01/2018

Application Instructions Wyoming Standard Educator License Add Endorsement

Attention: Adding Endorsements at the time of Initial/Reinstatement application

or Renewal - Applicants who are applying for initial/reinstatement licensure or whose

license has expired (i.e. the validity date has passed) should not fill out this application.

All forms related to adding endorsements at those times are included in each respective

application and can be found at: http://wyomingptsb.com/applications/.

Tips for Applicants

Before completing your application, read all instructions carefully. In order for PTSB to better serve you by processing your application quickly and efficiently, it is critical

that submitted application packets are complete and contain all supporting documentation as outlined in the instructions and on the forms.

PTSB does NOT accept photocopied, faxed, or scanned applications.

Application processing times vary throughout the year. Check our current processing time by visiting

the PTSB homepage: http://wyomingptsb.com.

It is the applicant’s responsibility to maintain current information (including Name, Mailing Address, Phone Number, and Email Address) on file with the Professional Teaching Standards Board. o To update your information please contact our office at 307-777-7291.

Applicants adding endorsements to current, valid licenses are NOT required to resubmit fingerprints or U.S./Wyoming Constitution Exams.

Application Process

Step 1 — Complete the Application Form

Section I – APPLICANT INFORMATION (Page 6) o Complete the information as outlined.

Section II – LICENSING AND LEGAL INFORMATION (Pages 6 and 7)

o Please make sure you carefully read and complete pages 6 and 7 of the application. o Any disclosure must be accompanied by a personal statement indicating the circumstances

and other related legal documentation (if applicable) to be considered complete. For more information regarding your personal statement, see page 6.

o Failure to disclose will delay your application. This may also lead to forfeiture of your fee, denial, or cancelation of your application.

o If you have any questions regarding your particular circumstance(s), please contact our office at 307-777-7291.

o Sign and date the application (see bottom of page 7) o Section III – INDIVIDUAL ENDORSEMENT REQUIREMENTS (Pages 8-10)

o Complete all boxes of this section which apply to your situation (see pages 8 – 10) and gather any documentation required.

o Include all appropriate documentation including official transcripts (see page 14), the Institutional Recommendation form (see page 12), and any testing requirement results for each added endorsement with your complete application packet.

o For information on adding an endorsement through work history, please see page 13. o If you have any questions regarding your particular circumstance(s), please contact our office at

307-777-7291.

Step 2 — Provide official transcripts (Page 14) Request official transcripts from ALL colleges and universities where coursework has been completed

and have them sent directly to you. Include the official transcripts with your completed application packet. No photocopied, faxed, or scanned copies are accepted.

o If you are submitting electronic transcripts please see page 14 for more information.

Transcripts must have your degree posted. Transcripts without the degree posted cannot be processed unless a degree was not earned at that institution.

NOTE: It is not necessary to submit official transcripts in a separate, sealed envelope; however, transcripts must contain the institution’s original seal and registrar’s signature in order to be considered “official”

http://wyomingptsb.com/


Step 3 — Provide Institutional Recommendation Form(s) showing program completion

[if applicable]

For endorsements being added by Institutional Recommendation, applicants must obtain an Institutional Recommendation (see page 12) from the institution(s) where they completed their preparation program(s).

After completing Section 1 of the Institutional Recommendation(s) form, submit the Institutional Recommendation(s) form to your College Dean or Certification Officer for completion. If you have questions as to where you should submit the form, please contact your specific institution.

Be sure to have the completed Institutional Recommendation(s) sent directly to you.

Once you have received your completed Institutional Recommendation(s), include them with your completed application packet.

Step 4 — Provide testing requirements results [if applicable]

In accordance with the Every Student Succeeds Act (ESSA) regulations, applicants are required to submit

proof of their status as Teacher of Record from any state in which they have been previously or currently

licensed with. Verification of this status needs to be submitted to PTSB, with the applicant’s application packet.

Proof of Teacher of Record status may be one of the following: o Any document verifying Teacher of Record status from a previous district or state. o A passing score on any test required by the previous state in order to obtain licensure in that

state.

Step 5 — Provide copies of current 1st Aid/CPR cards [if applicable]

All coaching applicants must provide current hands-on or hybrid 1st Aid/CPR Training o Applicants must submit copies of current, valid (front and back if applicable) 1st Aid/CPR

card(s), OR an original, signed letter verifying 1st Aid/CPR card(s) which must include: dates of the course(s), instructor’s contact information, and expiration date(s) of the 1st Aid/CPR certification(s).

Step 6 — National Board Certified Applicants [if applicable]

If you are a National Board Certified Teacher (NBCT) and wish to have this recognized on your license, please include a copy of your certificate verifying your NBCT status with your application packet. The notation will appear on the reverse side of your license.

Step 7 — Complete the Fee Payment Form (page 15)

The fees may be paid by personal checks, cash, money orders, cashier’s check, and credit card.

o Please make checks payable to PTSB or Professional Teaching Standards Board.

Wyoming Educator Preparation Program Testing Requirements Praxis II

Highly Effective Area Praxis Name Test Code Qualifying Score

Early Childhood Education

Education of Young Children 5024 160

Elementary Education Elementary Education: Multiple

Subjects

Reading and Language Arts 5002

157

Mathematics 5003

157

Social Studies 5004

155

Science 5005

159

Social Studies Comprehensive

Middle School Social Studies 5089 153

Social Studies: Content Knowledge

5081 158


Step 8 — Submit your complete application packet to PTSB

Your complete application packet should be submitted with the documents listed in the checklist below:

Submit your complete application packet to:

Professional Teaching Standards Board

1920 Thomes Avenue, Suite 100

Cheyenne, WY 82002

WYOMING PTSB APPLICATION CHECKLIST Check the appropriate box next to EACH item included)

I have completed Sections I and II – Legal and Licensing Information (see pages 6 and 7)

I have included a personal statement and court documents [if applicable] (see pages 6 and 7)

I have completed Section III – Individual Endorsement Requirements (see page 8-

10)

I have included my Verification of Employment form if applicable] (see page 11)

(for Alternative/Non-traditional School/At-Risk Youth Program or

Institutional/Private Residential Facility added endorsements only)

I have included the original Institutional Recommendation form(s) complete with

university seal [if applicable] (see page 12)

I have included the Verification of Work History form [if applicable] (see page 13)

I have included official transcripts from all institutions I have attended with degree(s) posted [if applicable] (see page 14) (photocopied, faxed, or scanned transcripts are not accepted)

I have included my PRAXIS II or OPI scores [if applicable]

I have included my Professional Development Plan narrative [if applicable] (for Alternative/Non-traditional School/At-Risk Youth Program or Institutional/Private Residential Facility added endorsements only)

I have included current copies of my 1st Aid/CPR card(s) [if applicable] (Coaching

applicants ONLY)

I have included credit card information, money order, or a check payable the Professional Teaching Standards Board or PTSB (see page 15)


Step 9 — Monitor application status

You may check the status of your application at any time by logging in to your online account via the PTSB website at http://wyomingptsb.com.

How to check your status: Step 1: Log in to your account. If you do not already have an account, you will need to click “Register for an Account” and create an account.

Step 2: Select “Educator Section: Click Here”

Step 3: Select “View Report of your Licensing Information”

Step 4: Underneath the applicant information section you will see the following:

Estimated application processing times:

These processing times are just estimates; they can be shorter or longer depending on each individual situation.

Help Us Avoid Processing Delays Our goal is to process your application and add an endorsement to your Wyoming Standard Educator License in a timely manner. To do that, we ask that you submit your application packet with complete and accurate information. If an application is received incomplete, you will receive a 30 Day Notice notifying you of your missing requirements. If the missing items are not received within the 30 days, your application may be canceled and your fee may be forfeited.

Fingerprints During the School Year During the Summer Months

NOT REQUIRED Two-to-four weeks Four-to-six weeks

REQUIRED Six-to-eight weeks Eight-to-twelve weeks

http://wyomingptsb.com/

- 6 - FORM_GREEN_ENDORSMENT Updated 05/01/2018

Wyoming PTSB Application Form This form is required for EVERY application.

You must submit this form with your complete application packet or your application will not be processed.

Legal Questions Found on Page 7

I. APPLICANT INFORMATION (INK ONLY)

Social Security No. (Required)

- - Legal Last Name (Required) Legal First Name (Required) MI Maiden / Other Name

Address Date of Birth

Mailing Address:

/ /

City: State: Zip Code: Gender (Optional)

Male Female

E-Mail Address: Phone:

Primary: ( ) Work: ( )

Ethnicity (Optional)

American Indian or Alaska Native

Anglo, Caucasian, White, not of Hispanic origin

Asian, Japanese, Chinese, Vietnamese, Korean, Filipino

Black, African American, not of Hispanic origin

Hispanic, Chicano, Cuban, Puerto Rican, Latino, Mexican American

Native Hawaiian or other Pacific Islander

Please verify the following information:

Yes No Are you legally eligible to work in the United States?

Yes No Are you now, or have you ever been, a member of the United States military?

Yes

No

Are you currently employed as an educator in Wyoming? (Teacher, Substitute, Administrator, Related Services, or Coach)

District and School: ____________________________________________________________________________________

Subject(s) and Grade Level(s) (if applicable): __________________________________________________________________

II. LICENSING AND LEGAL INFORMATION

IMPORTANT: Failure to answer any of the licensing and legal questions in a truthful and complete manner or failure to provide

truthful information or supporting documents could lead to your application being cancelled and fee forfeited. Failure to answer could also lead to disciplinary action toward any PTSB license or permit you possess.

All conduct must be disclosed. Even if:

It happened more than 10 years ago

It happened in another state, federal court, tribal, military,

or jurisdiction outside the United States

You did not go to court and your attorney went for you

You did not go to jail or the sentence was only a fine or

probation

You received a certificate of rehabilitation

NOTE: If your conviction was later dismissed, expunged,

set aside, or the sentence was suspended, you may be

required to provide court documentation verifying the final

disposition.

What to include in your personal statement:

Detailed explanation of each question marked “yes” on

page 7

Dates and locations

Final disposition and/or what was done to resolve the

situation

Documentation regarding:

o Disposition of arrest and/or conviction

o Any investigation or discipline on a professional

license

Below are examples of personal statements: Acceptable: “I was arrested for shoplifting in May of 1983. I was sentenced to pay restitution and received a fine of $300. I paid the restitution and fine and my case was closed. I contacted the court and was told my records are no longer available because the arrest happened over 30 years ago. The court provided me with the attached document which verifies that my records are no longer available.” Applicant Signature Unacceptable:

“I was convicted of a DUI in April 2003. Everything has been taken care of, and my case has been closed.” Applicant Signature

For more information, see the Licensing and Legal FAQs at http://wyomingptsb.com/frequently-asked-questions/faq-legal/

http://wyomingptsb.com/frequently-asked-questions/faq-legal/


II. LICENSING AND LEGAL QUESTIONS [Required]

BEFORE SIGNING, CHECK PAGES 6 AND 7 FOR COMPLETENESS:

Personal information with correct SSN, Mailing Address, Phone Number, E-Mail Address, and Date of Birth filled in on page 6

All legal questions marked “yes” or “no” on page 7

Signed, detailed personal statement attached (if applicable)

Court documents (if applicable)

WARNING: Answers to the following questions are required. For each question that applies to you, you must answer “yes”, EVEN IF you have already answered “yes” in a previous application. Answering “yes” does not lead to the automatic denial of your application. If you answer “yes” to any question, you must submit a signed personal statement and supporting documents (if applicable) even if you have previously submitted a statement.

For more information on personal statements, see page 6

1 Yes

No

Have you ever had any license, permit, or certificate from ANY professional licensing authority (education, nursing, speech-language pathology, etc.) suspended, revoked, voided, canceled, denied, rescinded, rejected, and/or otherwise taken away in Wyoming, any other state, or elsewhere?

2 Yes

No

Is there any action or investigation pending against a license, permit, or certificate held by you from ANY

professional licensing authority in Wyoming, any other state, or elsewhere?

3 Yes

No

Have you ever resigned, been disciplined, discharged, or asked to resign or retire from a professional position or military service because of allegations of misconduct, or is any such action pending?

IMPORTANT: This includes discipline for failure or refusal to fulfill an employment contract.

4 Yes

No

Have you ever been investigated, arrested, taken into custody, cited, charged, indicted, tried, pleaded guilty to, or convicted of a felony or misdemeanor, or been found to have committed a probation or parole violation? Exclude minor traffic violations such as infractions, parking tickets, and speeding tickets.

IMPORTANT: In responding to this question, include any pending investigation or charge. Include all cases

from federal, state, local, tribal, and military tribunals. You must also include all cases that were settled or closed by a withheld judgement or through retained jurisdiction, etc., or handled through juvenile proceedings. Even if you pleaded nolo contendere (no contest) you must disclose this. DUI’s or careless driving tickets stemming from a DUI are NOT considered minor traffic violations and must be reported.

5 Yes

No

Is there any information not disclosed by your answers concerning your background, history, experience, education, or activities which may have some bearing on your character, moral fitness or ability to hold a license, permit, or certificate in Wyoming and which should be placed at the disposal or brought to the attention of the Wyoming Professional Teaching Standards Board?

I attest and affirm that all statements made by me on this application are true and correct to the best of my knowledge. I understand that penalties, which may include revocation, suspension, denial, or refusal to renew, will be imposed under WS § 21-2-802 and PTSB Rules & Regulations, for making any false statement(s) on this application or required documents.

Applicant Printed Name _______________________________________________

Applicant Signature _______________________________________________ Date ______________________


III. INDIVIDUAL ENDORSEMENT REQUIREMENTS Please indicate which type of endorsement(s) you are applying to add by checking the appropriate box and completing all information in the corresponding section.

I would like to add an endorsement through an Institutional Recommendation

NOTE: Adding an endorsement through an Institutional Recommendation requires the completion of an approved program through a regionally accredited institution of higher education.

Adding an endorsement in a teaching content area(s)

An individual who holds a Wyoming Standard Educator License with an endorsement in specific teaching content area(s) is eligible to teach in any Wyoming school district in accordance with his or her level of preparation. List all endorsement area(s) you are applying for below. Endorsements added via Institutional Recommendation have the same validity dates as the license to which they are added.

I am applying for: __________________________________________________________________________

Requirements: Check EACH box below to indicate that you have met the requirement. Documentation for each requirement MUST be attached.

Institutional Recommendation indicating completion of a teacher preparation program from an accredited institution of higher education (see page 12).

Official transcripts with degree(s)/endorsement area(s) listed. No photocopied, faxed, or scanned transcripts are accepted (see page 14).

Praxis II scores. This is only required for Elementary Education, Early Childhood or Social Studies Comprehensive applicants.

Adding an endorsement as a School Administrator

An individual who holds a Wyoming Standard Educator License with a School Administrator endorsement is eligible to serve as administrator in any Wyoming school district in accordance with his or her level of preparation. Endorsements added via Institutional Recommendation have the same validity dates as the license to which they are added.

I am applying to add an endorsement as a:

District Superintendent School Principal Program Director


Institutional Recommendation indicating completion of a school administration program from an accredited institution of higher education

(see page 12).


Adding an endorsement in a Related Services area

An individual who holds a Wyoming Standard Educator License with a Related Services endorsement is eligible to serve in any Wyoming school in the professional service area of his or her preparation. Endorsements added via Institutional Recommendation have the same validity dates as the license to which they are added.

I am applying to add an endorsement as a:

School Psychologist School Counselor School Social Worker

School Nurse Speech-Language Pathologist


Institutional Recommendation indicating completion of a master’s degree in the appropriate field checked above (see page 12).


For a School Nurse endorsement, a copy of current Wyoming RN license or a letter from the Board of Nursing verifying licensure. A BSN is required.

I would like to add an endorsement through Work History

NOTE: This form needs to be completed by EACH district you have worked for in the last six years. Please exclude Substitute and Student Teaching.

Adding an endorsement in a teaching content area(s)

An individual who holds a Standard Educator License with an endorsement in specific teaching content area(s) is eligible to teach in any Wyoming school district in accordance with his or her level of preparation. List all endorsement area(s) you are applying for below. Endorsements added via Work History have the same validity dates as the license to which they are added.

I am applying for: __________________________________________________________________________


Verification of Work History form (see page 13).

Copies of all appropriate licenses that coincide with all dates of employment.


III. COACHING ENDORSEMENT REQUIREMENTS

This section is optional and ONLY APPLIES IF AN ADDITIONAL COACHING ENDORSEMENT AREA IS BEING ADDED to a Wyoming Standard Educator License.

I would like to add an endorsement for Coaching

A Coaching endorsement has the same validity dates as the license to which it is added.

NOTE: Applicants may only head coach in the specific sport in which they hold the specific endorsement(s).

Head Coach:

Please indicate the sport-specific area(s) for the Head Coaching endorsement(s) for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

Assistant Coach:

Please indicate the sport-specific area(s) for the Assistant Coaching endorsement(s) for which you are applying:

Basketball

Football

Golf

Skiing

Soccer

Swimming

Tennis

Track/Cross Country

Volleyball

Wrestling

All applicants who wish to add a Coaching endorsement must meet the following requirements:

Requirements: Check the boxes below to indicate that you have met each requirement. Documentation for each requirement MUST be attached.

Currently holds a valid Wyoming Standard Educator License in one (1) of the areas in Section III (see page 8)

Current Hands-on or Hybrid 1st Aid/CPR Training – applicants must submit copies of current, valid (front and back if applicable) 1

st Aid/CPR card(s)

OR an original, signed letter of verification in place of 1st Aid/CPR card(s) which must include: dates of the course(s), instructor’s contact

information, and expiration date(s) of the 1st Aid/CPR certification(s).

This requirement has been met by (choose one):

Red Cross Wyoming Coaching Association/Foundation Clinic

American Heart Association American Sport Education Program (ASEP)-Hybrid ONLY

National Federation of State High School Associations (NFHS)-Hybrid ONLY

Care and Prevention of Athletic Injuries (equivalent to two (2) semester hours)


College Transcript Wyoming Coaching Association/Foundation Clinic

Professional Development (This course must be at least 21 hours long and be conducted by a certified instructor.)

Foundations of Coaching, Theory of Coaching, Fundamentals of Coaching, or Coaching Principles


College Transcript Wyoming Coaching Association/Foundation Clinic (Fundamentals of Coaching)

National Federation of State High School Associations (NFHS) (Fundamentals of Coaching)

American Sport Education Program (ASEP) (Coaching Principles)

Applicants who wish to add a Head Coaching endorsement must meet the following additional requirement:

Prior Coaching Experience or “Theory of Each Specific Sport”


One (1) year of successful experience in each sport checked above as a coach, verified by supervisor on official school letterhead

Theory of Coaching the Specific Sport met by (choose one):

College Transcript American Sport Education Program (ASEP)

Wyoming Coaching Association/Foundation Clinic

ATTENTION: If you did not hold a permit or license with PTSB at the time you attended the coaching clinic, you will need to contact the Executive Director of the Wyoming Coaches Association/Foundation to get certificates of completion and submit them with this application (http://www.wcaonline.net/). If you have taken course(s) you feel meet any of these requirements please submit the course information for review.

http://www.wcaonline.net/


III. INDIVIDUAL ENDORSEMENT REQUIREMENTS continued Please indicate which type of endorsement(s) you are applying to add by checking the appropriate box and completing all information in the corresponding section.

I would like to add an endorsement for an Alternative/Non-Traditional School/At-Risk Youth Program.

An endorsement for Alternative/Non-Traditional School or At-Risk Youth Program has the same validity dates of the license to which it is added. An individual who holds this endorsement is eligible to teach in a designated program in any content area at the grade level for which he or she is endorsed.

NOTE: Applicants with this endorsement are only eligible to add this endorsement at the grade level(s) they will be teaching. Secondary teachers must teach at least one (1) course within their endorsement area(s).


Currently holds a valid Wyoming Standard Educator License in one of the areas in Section III (see page 8)

Verification of Employment (see page 11) by a Wyoming school district offering an Alternative Education, Non-Traditional, or At risk Youth Program

Professional Development Plan to verify your knowledge, skills, and competencies in this endorsement. Please list out what specific activities you plan to complete within the renewal period to strengthen your compliance to the standards, with the goal of becoming an expert working in your facility

I would like to add an endorsement for an Institutional/Private Residential Facility Teacher.

An endorsement as an Institutional/Private Residential Facility Teacher has the same validity dates of the license to which it is added. An individual who holds this endorsement is eligible to teach in any content area, at any grade level at an approved private facility.


Currently holds a valid Wyoming Standard Educator License in one of the areas in Section III (see page 8)

Verification of Employment (see page 11) by a Wyoming Institutional/Private School Facility

Professional Development Plan to verify your knowledge, skills, and competencies in this endorsement. Please list out what specific activities you plan to complete within the renewal period to strengthen your compliance to the standards, with the goal of becoming an expert working in your facility


VERIFICATION OF EMPLOYMENT (For Alternative/Non-Traditional/At-Risk, or Institutional/Private Residential

Facility Teachers Only) This form is used for one of the following endorsement areas only:

Alternative/Non-Traditional School/At-Risk Youth Program endorsement

Institutional/Private Residential Facility Teacher endorsement

Applicant Information

Applicant’s Legal Name (Required) Social Security No. (Required)

-

-

Mailing Address

Street: City: State: Zip:

Telephone No. Email Address


This Section to Be Completed by the Employer

To the Employer: The above applicant is applying to the Wyoming Professional Teaching Standards Board for an endorsement to

teach in one of the scenarios below, and as a requirement for approval, proof of present employment must be verified. Please complete this section and return this form to the applicant.

Please check the type of position the applicant holds:

Alternative/Non-Traditional School/At-Risk Youth Program - Grade Level(s)_____________

Institutional/Private Residential Facility Teacher

By signing below, the authorized district representative verifies that this applicant is currently employed in Wyoming as indicated above within the

school district or institution listed.

Authorized Signature Printed Name Title

Company Name or School District (Include District No.) Telephone No.

Mailing Address


I affirm that the information provided on this Verification of Employment is true and accurate to the best of my knowledge.

Signature Date


INSTITUTIONAL RECOMMENDATION Reminder: YOU MUST INCLUDE AN OFFICIAL TRANSCRIPT THAT HAS YOUR DEGREE POSTED

Section I – Applicant’s Legal Name (Required) Social Security No. (Required)

-

-

Mailing Address


IMPORTANT! THE APPLICANT MAY NOT COMPLETE ANY PORTION OF SECTION II BELOW. Section II is to be completed ONLY by the issuing institution’s official representative. Altering any information provided in Section II constitutes false representation and may be grounds for denial, suspension, or revocation of the applicant’s license.

Section II – College Representative: Please complete this section and return the original form to the applicant.

1

The above applicant is applying for a Wyoming Standard Educator License or endorsement. Please complete the information below to verify the state-approved professional education program(s) completed by this applicant at your institution.

Early Childhood Program Completion Date ____________________

Early Childhood, Birth to Age 8 (or grade 3)

Preschool, Birth to Age 5 (excluding Kindergarten)

Early Childhood Special Education, Birth to Age 5

Elementary Program Completion Date ____________________

Elementary K-6

Elementary & Middle 5-8 Please note that Wyoming does not offer a K-8 endorsement. Applicants who completed a K-8 program may be eligible for a 5-8 endorsement if ALL the following conditions are met:

1. The program was completed after 2002 2. The applicant completed methods coursework in all four

middle level core content areas 3. The applicant completed student teaching at the middle level 4. The applicant is eligible for single-subject content

endorsement(s) in your state

If all of the above requirements were met by the program, mark K-6 and 5- 8; otherwise, mark Elementary K-6 only.

Middle/Secondary Program Completion Date ____________________

Middle School 5-8

Endorsement area(s)

Content areas must be specified; General Middle School is not offered.

Secondary 6-12

Endorsement area(s)

Science 6-12 areas must be specified; General Science is not offered.

Special Education Program Completion Date ___________________

Generalist Grade Level(s) ___________________

Learning Disabilities

Cognitive Disabilities

Visual Disabilities

Physical Disabilities

Hearing Disabilities

Emotional Disabilities

K-6/K-12 Program Completion Date _____________________

Grade Level(s) _____________________

Endorsement area(s)

School Administrator Program Completion Date __________________

District Superintendent Grade Level(s) __________________

School Principal

Program Director/Coordinator/Supervisor

Related Services Program Completion Date __________________

School Psychologist

School Counselor

School Social Worker

Speech-Language Pathologist

2 Has the applicant met all state requirements to be eligible for licensure in the above listed endorsement area(s) in your state?

If you answered NO, do not sign this form; return it to the applicant with a detailed explanation. Yes No

3 Is a test required for program completers to Yes

receive an Institutional Recommendation? No

Name of test: Score required:

Date taken: Score received:

4 If you know of any reason this applicant should not teach in Wyoming schools, please send a separate statement to: PTSB, 1920 Thomes Ave., Suite 100, Cheyenne, WY 82002.

5

If the applicant is not eligible for an Institutional Recommendation OR you are not a representative of an institution of higher education, please do not sign this form. Representatives of Alternative Route Certification Programs must attach a detailed letter explaining their

organization’s program requirements.

Printed Name:

Title: Ph: ( )

College: State:

Regionally accredited by:

Signature: Date:

Only the signature of a Dean of the College, Certification Officer, or designee can be accepted.

PLACE COLLEGE SEAL

HERE

(Application cannot be

processed without the seal)


VERIFICATION OF WORK HISTORY

Applicant Information


-

-

Mailing Address


Telephone No. E-Mail Address


Work History

List all teaching, administrative, or other educationally related experience for three (3) out of the last six (6) years. Include only full-time assignments and assignments which required you to hold licensure or certification in the assignment area. Be very specific about which subjects were taught at the middle school or secondary levels, especially in the area of Science. Wyoming does not offer a Middle School Generalist endorsement or a General Science 6-12 endorsement.

This form needs to be completed by EACH district you have worked for three (3) out of the last six (6) years.

Please exclude Substitute and Student Teaching

Grade Levels Taught

Applicable Content Area(s) Taught or Administrator Position Exact Dates of Employment

Full-Time Position District or State Accredited Private School

EX: 6-12 Biology and Social Studies 8/10/2000 – 06/20/2016 Y / N

Cheyenne District #3

Y / N

Y / N

Y / N

Y / N

Y / N

Include copies of the appropriate licenses that coincide with your work history, covering all dates of employment listed above.

This section to be completed by Applicant’s School Administrator

To the Administrator: Please review your records and verify the applicant’s teaching and/or administrative experience for your district ONLY and return the form to the applicant. If you know of any reason this applicant should not teach in Wyoming schools, please send

a separate statement to: PTSB

1920 Thomes Ave. Suite 100

Cheyenne, WY 82002

Authorized Signature Printed Name Title

School District (Include District No.) Telephone No.

Mailing Address


I affirm that the information provided on this Verification of Work History is true and accurate to the best of my knowledge.

Signature Date


VERIFICATION OF REQUESTED OFFICIAL TRANSCRIPTS For more information on submitting transcripts please visit:

http://wyomingptsb.com/licensure/becoming-licensed/official-transcripts/

Transcripts are required from ALL institutions attended.


-

-

Mailing Address


Telephone No. E-Mail Address


ATTENTION: If you were enrolled under a different name (first or last) while attending any of the colleges or universities listed below, make sure to indicate it below or the application process will be delayed. Official Electronic Transcripts:

o Electronic transcripts must be sent to PTSB directly from the college/university. Please have electronic transcripts emailed to [email protected].

Official Hard Copy Paper Transcripts:

o Official hard copy paper transcripts must be included with your paper application. Please DO NOT request the transcripts to be sent to PTSB separate from your complete application.

NOTE: If you submit official hard copy transcripts separate from your application packet or transcripts from ALL institutions attended are not received, your application will be considered incomplete, delaying the application process.

Date Requested Hard Copy Included

Electronic Requested

College/University Name

Maiden/Other Names While Attending

EX: 01/01/2017 University of Wyoming Mickey Mouse

http://wyomingptsb.com/licensure/becoming-licensed/official-transcripts/

mailto:[email protected]


ADD ENDORSEMENT FEE PAYMENT FORM

Make fees payable to PTSB or Professional Teaching Standards Board Fees may be paid by personal check, cash, money order, cashier’s check, or credit card. Checks must be written in black or dark blue ink only. Please be sure the applicant’s full name is written on the check.

NOTE: If you are adding one or more of these endorsement areas at once there is ONLY ONE fee needed to process the multiple endorsement areas

Add Endorsement Fee $________________

Total Amount of Fees $______________

ONE PAYMENT MAY BE SUBMITTED TO COVER ALL APPLICABLE FEES

Make fees payable to PTSB or Professional Teaching Standards Board and staple check (written in black or dark blue ink) or

money order here or complete credit card information below: (VISA, DISCOVER, & MASTERCARD are accepted)


- -

I AM MAKING PAYMENT BY CHECK, CASH, MONEY ORDER, OR CASHIER’S CHECK. PTSB ID #:

I AM MAKING PAYMENT BY CREDIT CARD.

Cardholder Name (please print):

__________________________________

Cardholder Contact Number:

__________________________________

Cardholder Billing Address:

__________________________________ Street/PO Box

____________________________________ City State Zip

Visa MasterCard Discover

Credit Card Number:

- - - Expiration Date: CVC Code: (found on signature line, 3 to 4 digits)

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_____________________________________________ Cardholder Signature Date

THIS PAGE WILL BE SHREDDED AFTER PAYMENT HAS BEEN PROCESSED.

NOTE: Submitting an incorrect fee will delay the processing of your application. Please contact our office if you have

questions at 307-777-7291.

** ALL FEES ARE PROCESSED IMMEDIATELY AND ARE NON-REFUNDABLE **

Professional Teaching Standards Board 1920 Thomes Ave. Suite 100, Cheyenne, WY 82002

Fees

Add Endorsement through Institutional Recommendation $50

Add Endorsement through Verification of Work History $50

Head Coaching Endorsement $50

Assistant Coaching Endorsement $50

Alternative/Non-Traditional/At-Risk Youth Program Endorsement $75

Institutional/Private Residential Facility Teacher Endorsement $75

Download - Professional Teaching Standards Board - Wyoming. PTSBwyomingptsb.com/wp-content/uploads/applications/Add... · 2018-06-15 · Professional Teaching Standards Board Wyoming Standard

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