Form D "Interim Teacher's Certificate - United States Educated Teacher" - New Brunswick, Canada

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Download Form D "Interim Teacher's Certificate - United States Educated Teacher" - New Brunswick, Canada

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FORM D
INTERIM TEACHER’S CERTIFICATE
United States Educated Teacher
Personal Information:
Name: _________________________________________________________________________________________
Surname
Maiden
First Name
Middle Name
SIN:
_______________________________________
Gender (please circle) M
/ F
Date of Birth: __________________________________
Country of Birth: _____________________________
(YYYY)
(MM)
(DD)
Mailing Address:
Telephone Numbers:
_______________________________________________
Home: _____________________________________
_______________________________________________
Work: _____________________________________
_______________________________________________
Cell:
_____________________________________
E-mail Address: ________________________________
Teacher Training Completed in (State): ______________________________________________________________
University/Professional Training:
Degree
Major
Minor
Institution
Year
Bachelor’s
(other than
Education)
Bachelor’s (Ed.)
Master’s
Other
Reset
FORM D
INTERIM TEACHER’S CERTIFICATE
United States Educated Teacher
Personal Information:
Name: _________________________________________________________________________________________
Surname
Maiden
First Name
Middle Name
SIN:
_______________________________________
Gender (please circle) M
/ F
Date of Birth: __________________________________
Country of Birth: _____________________________
(YYYY)
(MM)
(DD)
Mailing Address:
Telephone Numbers:
_______________________________________________
Home: _____________________________________
_______________________________________________
Work: _____________________________________
_______________________________________________
Cell:
_____________________________________
E-mail Address: ________________________________
Teacher Training Completed in (State): ______________________________________________________________
University/Professional Training:
Degree
Major
Minor
Institution
Year
Bachelor’s
(other than
Education)
Bachelor’s (Ed.)
Master’s
Other
SUPPORTING DOCUMENTATION:
 Payment of $120.00 CAD, in the form of money order or cheque, payable to the Minister of Finance, Province of
New
Brunswick.
 Official transcripts from the originating institution of all academic and professional training even if credit has been
transferred from one institution to another. In order to remain official, transcripts must be submitted in envelopes
sealed by the institution and included with the application or sent directly from the institution to our office.
 An official completed Criminal Record Check document through the Royal Canadian Mounted Police or the local
police force in area of residence. Out-of-province applicants (having resided in New Brunswick less than two years)
must obtain such information from the local police jurisdiction in their home state.
 A Statement of Professional Standing (SOPS) is required from each jurisdiction where a teacher has been
certified. This is not a copy of a license or a certificate.
 Non-Canadians must submit verification of Canadian Landed Immigrant Status/Work Visa.
DECLARATION:
I certify that all information given on this application is true, correct, and complete to the best of my knowledge. I
authorize any person, government, educational institution, police force, military authority, governing body, or other
organization enquired of under this authorization to provide the New Brunswick Department of Education and Early
Childhood Development all relevant information requested. I accept responsibility for advising the Department, in
writing, of any change to the information contained in this application.
_______________________________________
_____________________________________
Signature
Date
Please ensure that all possible supporting documents are included when submitting your application
and allow 4 weeks to 25 work days processing after all documents have been received.
Office of Teacher Certification - Department of Education and Early Childhood Development
P.O. Box 6000 Fredericton, NB E3B 5H1, Tel.: (506) 453-2785, Fax: (506) 453-5349
teachercertification@gnb.ca
Interim certificate:
An Interim Certificate enables a person who has obtained his or her education degree outside of Canada
to teach in New Brunswick for a period of four years. Upon successful completion of two years of
contractual teaching experience (1 year = 195 days) in the New Brunswick Public School system, and any
other prescribed conditions, an Interim Certificate may be converted to a permanent Teacher’s Certificate.
The Department of Education and Early Childhood Development’s decision on the eligibility of the
applicant for an Interim Certificate is based on the regulation governing certification at the time of
evaluation. An Interim Certificate does not guarantee employment.
Candidates Applying For An Interim Certificate Must Possess:
An approved undergraduate degree which contains a minimum of 138 credit hours of which a minimum of
18 credit hours shall represent an approved practicum* (a minimum of 18 weeks) and a minimum of 30
credit hours shall represent professional educational course work.
*Verified successful teaching experience may be acceptable for a portion or in lieu of this practicum.
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