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Please read the following information:

Please complete the information requested below to be included in the 2008-2009 Instructional Registry.  The information you provide will be given to our certification staff to verify you teaching eligibility for the 2008-2009 school year.  Once you have been approved, you will be notified via e-mail that your name and approved subject area(s) have been added to the registry.  If our certification specialist are unable to verify your eligibility, your name will not be added to the registry and supplemental documents will not be reviewed.

The approved candidate registry will be made available to our principals on July 1, 2008 as a hiring resource for the 2008-2009 school year.

Instructional Registration Form
(Request to be included on the 2008-2009 Instructional Registry)

* Indicates required field to complete.

*Today's Date [mm/dd/yyyy]:                                          

 *First Name:     Middle Initial:    *Last Name:  
 

*Address:  
 

*City:         *State [abbreviation]:                *Zip Code:  

 

E-mail:   


*Phone No. [(XXX) XXX-XXXX]:            *Cell or Alternate Phone No. [(XXX) XXX-XXXX]:   
                                                          

 

*Date of Birth [MM/DD/YYYY]:                                     Social Security Number [XXX-XX-XXXX] :

                                                                                                                                                           (To verify certification information only.)

                                                                                                                  

*Work Authorization:                                                           U.S. Citizen   Permanent Residence

 

Work Desired

Please list the subject areas and grade levels that you are qualified to teach.

1:    2:

 

3:    4:
 

Education

Degrees earned to date.

*B.A.:   Yes    No  *If yes, please indicate major:   
 

  M.A.:   Yes   No   If yes, please indicate major: 


  Post graduate:    Yes       No    If yes, please indicate major:

Please provide the information below regarding your Teacher Certification
 (Click here for information regarding Florida's Certification Requirements)

                                                                         State           Yr Issued        Yr Expires
          Subject Area                                       [Abbreviation]         [YYYY]                 [YYYY]                        

                                                        

                                                        

                                                            

                                            
                                             Years of teaching experience? 

 

Florida Teacher Certification Examination
For information on the Florida Teacher Certification Examination (FTCE), please visit: www.fl.nesinc.com

(Praxis is not acceptable in Florida, unless it is part of your Highly Qualified Teacher Certification in another state.)

 

        Test Type                 Date Taken             Passed or Failed                 Subject Area

                                         [MM/DD/YYYY]

Subject Area Exam (SAE)               Passed    Failed       
 

General Knowledge (GK)           Sections Passed?   Math  Reading  Language  Essay

 

Professional Exam                         Passed    Failed   

 

Have you received or applied for a Statement of Eligibility from the Florida Department of Education?  Yes    No

If yes, what does it state that you are eligible to teach? 

 

Are you a current or previous employee of Brevard Public Schools?  Yes     No  

If yes, when and what was the title of your position:  

 

*Please list most recent employer:                                                         

 

The following information is voluntary:
     Gender:  Male   Female
     Race:  White, Non-Hispanic  Black, Non-Hispanic  Hispanic  Asian/Pacific Islander American Indian/Alaskan Native

For information on the Florida Teacher Certification Examination (FTCE) please visit:  www.fl.nesinc.com

Please print before submitting this registration form.

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