Certification Renewal/Add-On Verification

CERTIFICATION DEPARTMENT 3300 FOREST HILL BLVD., SUITE A-152 WEST PALM BEACH, FL 33406

Certification Renewal/Add-On Verification

Employee ID#

DOE#/License#

School/Department

First Name

Last name

Email

Phone

1. Application must be submitted online to the FLDOE Website

*Date Application was submitted to FLDOE: _______________

2. Mark the appropriate section below and attach required documentation.

Documentation for Renewal

Documentation for Add-On

The In-Service requirement for Renewal is 120 points, to include 20 in ESE. Indicate below the method of renewal:

In-service points earned through PBC

# of In-service Points______ ESE Points______

Official transcript (attach or on file) Subject Area Exam College Teaching Experience National Board cert (attach or on file)

Subject to be Added: _____________________

In-service points earned through PBC Official transcript (attach or on file) Subject Area Exam

3. Select Payment Method

Payroll Deduction ? Available September 1st through May 1st (NOT AVAILABLE FOR CHARTER SCHOOLS) District Online Credit Card Payment (attach receipt)



4. Return this form to: CERTIFICATION OFFICE SUITE A-152

In-Service Points Verified Bank Updated

FOR OFFICE USE ONLY

Payment Received Transmitted to FLDOE

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