College of Education

Teaching License Application

Please complete ALL fields.

First Name
Middle Name
Last Name
Maiden Name/other last name aliases
Date of Birth (e.g. 2/13/91)
T-Number
Gender
Street/P.O. Box
City
State
Zip
Telephone Number - include area code
E-mail address
Cell Phone Number/Alternate Phone Number
Which of the following are you applying for -check all that apply.





INFORMATION NEEDED FOR FEDERAL REPORTING - COMPLETE BOTH ETHNICITY & RACE
Ethnicity
Race
PLEASE READ CAREFULLY BEFORE SUBMITTING - MUST BE COMPLETED
Personal Affirmation: Failure to complete this section will result in your application being returned without processing. False statements made in this application may constitute grounds to take action, revoke or deny a license. Check the appropriate block for each question. DO NOT include matters that the State Board of Education has already investigated and found "No Probable Cause" to take any disciplinary action.
1. Have you been convicted of a felony, including conviction on a plea of guilty, a plea of nolo contend ere or order granting pre-trial diversion?
2. Have you been convicted of the illegal possession of drugs, including conviction on a plea of guilty, a plea of nolo contend ere or order granting pre-trial diversion?
3. Have you had a teacher's certificate/license revoked, suspended or denied, or have you voluntarily relinquished a certificate/license? (Allowing a license to expire does not count.)
4. Is there any action pending against your certificate/license or application in another state?
Please list the edorsement area(s) being requested for this application:




 
Are your passing test scores showing in TN Compass?       If no, list the testing date.  (e.g. 2/13/14)
By signing this form, I agree that the above information is correct to the best of my knowledge and give TTU's College of Education permission to submit my application for a State of Tennessee Educator License.
    



College of Education