Form D "Interim Teacher's Certificate Application Form for United States Candidates" - New Brunswick, Canada

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Interim Teacher’s Certificate Application Form
FORM D
for United States Candidates
Interim Certification Level Requested
Consult the requirements and check the appropriate level.
Interim Teacher’s Certificate 4 
Interim Teacher’s Certificate 5 
Interim Teacher’s Certificate 6 
REQUIREMENTS FOR EACH LEVEL OF CERTIFICATION
Approved bachelor’s degree in education
Approved bachelor’s degree in education
A person who meets the requirements
for an interim teacher’s certificate 5
Minimum of 138 university credit hours
Minimum of 168 university credits hours
and has completed:
including:
including:
an approved Master of Education
30 credits in pedagogical training and
45 credits in pedagogical training and
o
o
o
degree or a Master’s degree in a
18 credits (or 18 weeks) of approved
15 credits (or 15 weeks) of approved
teachable subject with 30 credit
practice teaching including, and
practice teaching, and
hours at the 6000 level, or
a major (30 credits) in a teachable
a major (30 credits) in a teachable
o
o
a non-degree program with
subject or a combination of a major
subject or a combination of a major
o
30 credit hours at the 6000 level
(24 credits) and a minor (18 credits)
(24 credits) and a minor (18 credits) in
that leads to an additional major or
in two teachable subjects.
two teachable subjects.
two additional minors.
Personal Information
Last name
First Name
Middle Name
Maiden Name
SIN:
Gender
Male 
Female 
Non-binary 
Date of Birth:
Telephone Numbers:
(YYYY)
(MM)
(DD)
Home
Work
Cell
Email Address:
1
Reset
Interim Teacher’s Certificate Application Form
FORM D
for United States Candidates
Interim Certification Level Requested
Consult the requirements and check the appropriate level.
Interim Teacher’s Certificate 4 
Interim Teacher’s Certificate 5 
Interim Teacher’s Certificate 6 
REQUIREMENTS FOR EACH LEVEL OF CERTIFICATION
Approved bachelor’s degree in education
Approved bachelor’s degree in education
A person who meets the requirements
for an interim teacher’s certificate 5
Minimum of 138 university credit hours
Minimum of 168 university credits hours
and has completed:
including:
including:
an approved Master of Education
30 credits in pedagogical training and
45 credits in pedagogical training and
o
o
o
degree or a Master’s degree in a
18 credits (or 18 weeks) of approved
15 credits (or 15 weeks) of approved
teachable subject with 30 credit
practice teaching including, and
practice teaching, and
hours at the 6000 level, or
a major (30 credits) in a teachable
a major (30 credits) in a teachable
o
o
a non-degree program with
subject or a combination of a major
subject or a combination of a major
o
30 credit hours at the 6000 level
(24 credits) and a minor (18 credits)
(24 credits) and a minor (18 credits) in
that leads to an additional major or
in two teachable subjects.
two teachable subjects.
two additional minors.
Personal Information
Last name
First Name
Middle Name
Maiden Name
SIN:
Gender
Male 
Female 
Non-binary 
Date of Birth:
Telephone Numbers:
(YYYY)
(MM)
(DD)
Home
Work
Cell
Email Address:
1
Mailing Address
Street
Apt.
City
State
Zip Code
University Education
DEGREE
Number
Major
Minor
Institution
Graduating
of credits
(without a minor:
(18 credits)
Year
30 credits –
with a minor:
24 credits)
Bachelor’s degree
other than Education
Bachelor’s degree in
Education
Master’s degree
Other post-secondary
degree
Required Fee and Documentation
Fee: $120.00
Money order or cheque, payable to the Minister of Finance, Province of New Brunswick.
No other form of payment is accepted.
Official Transcript
Official transcripts from the originating institution of all academic and professional training even if credits have
been transferred from one institution to another. Transcripts must be sent directly to the Office of Teacher
Certification by institutions issuing them, either by email or by mail. A transcript in an envelope sealed by the
institution will also be accepted. If submitting transcripts prior to graduation, please ensure all courses
including the internship are graded and if a degree is intended, a letter from the institution’s registrar’s office
indicating that the requirements have been met and graduation is expected.
Criminal record check:
A criminal record check must have been completed within 12 months of the date of the signing of this form.
The document should be signed, dated and contain the official seal of the police force where the check was
performed. Copies are not accepted. An online criminal record check may be accepted if it is provided by a
police service and contains an authentication method.
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Statement(s) of professional standing
For any country where you have taught, you must provide an official statement of professional standing from the
regulating body or government. This document must:
be printed on letterhead, dated and signed,
confirm that you have the right to teach,
confirm you have never been found guilty of professional misconduct,
confirm that your authorization to teach has never been suspended or revoked.
The document must be sent directly to the Office of Teacher Certification by the institution issuing the statement,
either by email or by mail. A statement in an envelope sealed by the institution will also be accepted.
Employability Status:
Non-Canadians must submit a copy of their Permanent Resident Card or a copy of their Work Visa.
The Office of Teacher Certification reserves the right to request other documents.
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,
administration, 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 with 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
Contact Information
Mailing Address
Physical Address
Office of Teacher Certification
Office of Teacher Certification
Department of Education and Early Childhood
Department of Education and Early Childhood
Development
Place 2000
P.O. Box 6000
250 rue King
Fredericton NB E3B 5H1
Fredericton NB E3B 9M9
Tel.: 506-453-2785
Fax: 506-453-5349
teachercertification@gnb.ca
Important deadlines and information
Certificate dated July 2: Apply before October 31 of the same year (provided coursework has been completed
by August 31 of the same year).
Certificate dated January 2: Apply before March 31 of the same year (provided coursework has been
completed by December 31 of the previous year).
Please ensure that all supporting documents are included when submitting your application. Files are not
processed until all required documents are received by the Office of Teacher Certification. Allow 20 to 25 work
days for processing after all documents have been received.
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