"Statement of Professional Standing Request Form" - British Columbia, Canada

ADVERTISEMENT
ADVERTISEMENT

Download "Statement of Professional Standing Request Form" - British Columbia, Canada

114 times
Rate (4.5 / 5) 6 votes
Statement of Professional
Standing Request Form
If you hold, or have held, a BC teaching certificate and are applying for a teaching credential from a licensing
body outside of BC, the licensing body to which you are applying (usually a College of Teachers or
Ministry/Department of Education) will require that a Statement of Professional Standing be sent directly from
our office.
Pursuant to section 33.1(1)(l) of the Freedom of Information and Protection of Privacy Act, the statement shall confirm
the status of your certification in BC and report any completed or open professional conduct matter regarding
your teaching in BC. We will mail the original statement directly to the licensing body to which you are applying
and a copy of the statement to you for your reference.
The processing fee for each statement is $35.00 (see page 2 for payment options).
You may submit this form to us by mail or by fax at 604 775-4859.
YOUR INFORMATION
Date of Birth
File/Certificate No.
(YYYY/MM/DD)
Given Names
Surname
Previous Surnames
Mailing Address
Home Telephone Number
Work Telephone Number
Email Address
(include area code)
(include area code)
RECIPIENT INFORMATION
Name of Licensing Body
Mailing Address
Mailing Address
REQUEST TO RELEASE INFORMATION
I hereby request that the Ministry of Education send the above recipient a Statement of Professional Standing
concerning the status of my teaching certificate and my conduct record (if any).
Signature
Date Signed
Continued on page 2
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
Statement of Professional
Standing Request Form
If you hold, or have held, a BC teaching certificate and are applying for a teaching credential from a licensing
body outside of BC, the licensing body to which you are applying (usually a College of Teachers or
Ministry/Department of Education) will require that a Statement of Professional Standing be sent directly from
our office.
Pursuant to section 33.1(1)(l) of the Freedom of Information and Protection of Privacy Act, the statement shall confirm
the status of your certification in BC and report any completed or open professional conduct matter regarding
your teaching in BC. We will mail the original statement directly to the licensing body to which you are applying
and a copy of the statement to you for your reference.
The processing fee for each statement is $35.00 (see page 2 for payment options).
You may submit this form to us by mail or by fax at 604 775-4859.
YOUR INFORMATION
Date of Birth
File/Certificate No.
(YYYY/MM/DD)
Given Names
Surname
Previous Surnames
Mailing Address
Home Telephone Number
Work Telephone Number
Email Address
(include area code)
(include area code)
RECIPIENT INFORMATION
Name of Licensing Body
Mailing Address
Mailing Address
REQUEST TO RELEASE INFORMATION
I hereby request that the Ministry of Education send the above recipient a Statement of Professional Standing
concerning the status of my teaching certificate and my conduct record (if any).
Signature
Date Signed
Continued on page 2
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
Statement of Professional
Standing Request Form
Page 2/2
PAYMENT INFORMATION
If you wish to pay the processing fee by credit card, please complete the authorization form below. Otherwise,
please enclose a cheque or money order payable to the Minister of Finance.
Name of individual or business as it appears on the card:
Please choose one:
Visa
MasterCard
American Express
Credit Card Number
Expiry Date (MM/YY)
Total Payment Authorized
$35.00
Signature of card holder:
Date (YYYY/MM/DD)
Please note: Credit card data should not be emailed. The credit card information provided on this form will not be
retained. Upon authorization of the payment request, all credit card information will be destroyed.
January 2016
Ministry of Education
Teacher Regulation Branch
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver BC V6J 1Z6
Facsimile: 604 775-4859
Page of 2