"Application for First Nations Language Teacher's Certificate of Qualification - Language Authority Form" - British Columbia, Canada

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Application for First Nations
Language Teacher’s
Certificate of Qualification
Language Authority Form
FNLCLA AUG 2019
TO BE COMPLETED BY THE APPLICANT PRIOR TO FORWARDING TO THE LANGUAGE AUTHORITY
Given Names
Surname
Used Given Name
Birth Surname
Other Previous Surname
Ancestral First Nation Name (Optional)
Street Address/P.O. Box
City/Town
Province/State
Country
Postal Code/Zip Code
Email Address
Home Phone Number (include area code)
Work Phone Number (include area code)
TO BE COMPLETED BY THE LANGUAGE AUTHORITY
Language of Instruction
Recommending Language Authority
Language Authority Address and Contact Person:
Title
Contact Person (Please print name)
Telephone Number (include area code)
Email Address
Street Address/P.O. Box
City/Town
Province/State
Country
Postal Code/Zip Code
Application for First Nations
Language Teacher’s
Certificate of Qualification
Language Authority Form
FNLCLA AUG 2019
TO BE COMPLETED BY THE APPLICANT PRIOR TO FORWARDING TO THE LANGUAGE AUTHORITY
Given Names
Surname
Used Given Name
Birth Surname
Other Previous Surname
Ancestral First Nation Name (Optional)
Street Address/P.O. Box
City/Town
Province/State
Country
Postal Code/Zip Code
Email Address
Home Phone Number (include area code)
Work Phone Number (include area code)
TO BE COMPLETED BY THE LANGUAGE AUTHORITY
Language of Instruction
Recommending Language Authority
Language Authority Address and Contact Person:
Title
Contact Person (Please print name)
Telephone Number (include area code)
Email Address
Street Address/P.O. Box
City/Town
Province/State
Country
Postal Code/Zip Code
Application for First Nations Language Teacher’s Certificate of Qualification
Language Authority Form Page 2
Declaration of Language Authority
We, the undersigned, hereby declare to the Ministry of Education that, to the best of our knowledge,
__________________________________ (Name) is a fit and proper person to teach our First
Nation’s Language and Culture; and
We also declare that this person is a proficient speaker of our First Nation’s Language
and has a broad understanding of our culture and society.
Authorized Signature(s) for Language Authority
Name in full
Signature
Date
Name in full
Signature
Date
Name in full
Signature
Date
Name in full
Signature
Date
Name in full
Signature
Date
Please contact the Ministry of Education at 604 660-6060 or 1 800 555-3684 should you require more information or
assistance in completing the application.
Ministry of Education
Mailing Address:
Telephone: 604 660-6060
400-2025 West Broadway
Toll Free: 1 800 555-3684
Vancouver B.C. V6J 1Z6
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