Certificate of Teaching Experience Form
For Additional Qualifications for Teachers Courses

Name   ______________________________

UWO Student Number   ___________________

Course applied for  ______________________

Session   ____________________________

 

PLEASE CHECK APPROPRIATE BOX AND HAVE YOUR SUPERINTENDENT SIGN BELOW.
Note: Teaching experience MUST BE COMPLETED prior to the first day of the course.  Incomplete Teaching Experience forms cannot be processed.

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PART TWO OF A THREE-PART COURSE
This is to certify that the applicant named above has completed one year (194 days or 110 hours of regular classroom contact) of successful teaching experience.  If the applicant is planning to take the Specialist course at Western and has already completed the appropriate experience, you may check below as well.  This information will then be kept on file.
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SPECIALIST/HONOUR SPECIALIST OR HONOUR TECHNOLOGICAL EDUCATION SPECIALIST COURSES
This is to certify that the student named above has completed two years (388 days) of successful teaching experience, of which at least one year (194 days or 110 hours of regular classroom contact) is in Ontario in the following subject area
(required)__________________________________________.
NOTE: Where candidates are teaching the subject identified above in an integrated format, supervisory officers may consider experience where a teacher can demonstrate that significant program and instructional modifications were explicitly planned, implemented and reviewed in the teacher’s class: Drama, ESL, FSL, Guidance and Career Education, Integration of Info & Comp Tech in Instruction, Music, Reading, Special Education, or Visual Arts (OCT Memorandum; July 14, 2004).
   

 

______________________________________

  

______________________________________

Signature of Supervisory Officer (not principal)

  

Name (printed) of Supervisory Officer
     
______________________________________   ______________________________________

Position of Supervisory Officer

  

Board of Education
     
______________________________________   ______________________________________

Date

  

Phone or email

 

FAX the completed form to 519-850-2526 (original not required).
Continuing Teacher Education
Faculty of Education
1137 Western Rd,
London, ON
N6G 1G7