Transcription of APPLICATION FOR KENTUCKY CERTIFICATION OR CHANGE …
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APPLICATION FOR KENTUCKY CERTIFICATION OR CHANGE …
Page 1 CERTIFICATION APPLICATION (CA-1) Commonwealth of KENTUCKY KENTUCKY DEPARTMENT OF EDUCATION Division of Educator Licensure and Quality, 300 Sower Blvd., 5th Floor, Frankfort, KENTUCKY 40601 Telephone (502) 564-4606 (888) 598-7667 APPLICATION FOR KENTUCKY CERTIFICATION OR CHANGE IN SALARY RANK Read instructions before completing APPLICATION . An incomplete APPLICATION will delay processing. SECTION I. Record of Personal Information and Preparation to be completed BY APPLICANT (type or print) A. PERSONAL INFORMATION SSN:_____ Date of Birth: _____ Last Name: _____ Suffix: _____ First Name: _____ Middle: _____ Maiden Name: _____ Gender: Male Female Mailing Address: _____ City: _____ State: _____ Zip Code: _____ Telephone Number (_____) _____ Home Mobile Primary E-mail address: _____ Secondary E-mail address: _____ Ethnic Identification Optional (check one) White, Non-Hispanic Black, Non-Hispanic Hispanic Asian or Pacific Islander American Indian Other Are you a veteran of the United States Armed Forces or Reserves with at least six (6) years of service?
completed two (2) years of acceptable full-time or half-time (.5) teaching experience at that grade level and content area for which teacher certification is requested, will be exempted from the PRAXIS II and Principles of Learning and Teaching (PLT) tests and from the Kentucky Teacher Internship Program (KTIP).
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