Application Information. for recent graduates of a BC teacher education program

Application Information for recent graduates of a BC teacher education program August 2015

Table of Contents About the BC Ministry of Education Teacher Regulation Branch... 2 Certificates Issued... 3 How to Apply for Your Certificate... 4 Required Forms and Documents... 5 Additional Information... 9 The Standards... 10

About the BC Ministry of Education Teacher Regulation Branch About Us The Teacher Regulation Branch is a part of the Ministry of Education. Its mandate is to regulate educators and is empowered through the Teachers Act to ensure that educators who work with students in BC classrooms are competent and suitable for the important role they play in society. No other occupation spends as much time with their clients as do educators. Parents entrust their children to the care of educators for seven hours a day, five days a week, 40 weeks a year, for 13 years. This intense interaction has an immense impact on children's intellectual, emotional and physical development. The Branch works to ensure that educators are well-educated and prepared for their important work with children and the responsibility they share with parents to raise strong, healthy and informed citizens. The Branch came into being in 2011 under the Teachers Act to assess applicants for certification, issue certificates of qualification, conduct reviews of certificate holders and suspend or cancel certificates when necessary. These responsibilities were formally held by the BC College of Teachers, which existed from January 1, 1988 to January 9, 2012. Certificate holders include classroom teachers, vice-principals, principals, directors and superintendents in the public, independent and First Nations school systems in BC. To learn more about the Teacher Regulation Branch, visit us at www.bcteacherregulation.ca. Office Location BC Ministry of Education Teacher Regulation Branch 400-2025 W Broadway Vancouver BC V6J 1Z6 Canada Contact Information Telephone: 604 660-6060 Toll-Free (within Canada and the United States): 1 800 555-3684 Fax: 604 775-4859 Website: www.bcteacherregulation.ca 2

Certificates Issued All educators working in BC s kindergarten to grade 12 public education sector must hold a certificate of qualification from the BC Ministry of Education. This certificate also enables educators to work in all independent schools and First Nations schools in the province. Your application may result in your qualifying for a Professional, Conditional or Developmental Standard Term Certificate. Professional and Conditional Certificates are not restricted to any subject area or grade level, and they are valid for BC s kindergarten to grade 12 education system. The Developmental Standard Term Certificate is restricted to a specific subject. Professional Certificate This is a non-expiring certificate issued to applicants who have met all of the requirements for teacher certification specific to BC. Trades Certificate This is a non-expiring certificate that restricts the holder to teaching in a specific trade area. Teachers who qualify for a Trades Certificate will have the option of upgrading to a Professional Certificate by completing specific requirements. Conditional Certificate This is an expiring certificate valid for up to 60 months. This certificate is issued to applicants who have met the minimum requirements for BC certification and do not have a current, valid, unrestricted teaching certificate from another Canadian province or territory. To be able to continue teaching in BC longer than 60 months, coursework must be completed to upgrade to a Professional Certificate. This coursework must be completed before the Conditional Certificate expires. Developmental Standard Term Certificate This is an expiring certificate valid for up to 60 months. It is restricted to a specific specialty area such as cook instruction or technology education. Teachers who qualify for this certificate must have completed a basic academic program, an acceptable teacher education program and either an interprovincial trades qualification or First Nations program of studies that the Ministry recognizes. Specific coursework requirements must be completed before the certificate expires to upgrade to a Professional Certificate. 3

How to Apply for Your Certificate To apply for your certificate of qualification You may apply online or with paper forms. To apply online, please visit the Applicants Area on our website at www.bcteacherregulation.ca. To apply using the paper forms, please proceed with the following steps. Keep in mind that proceeding with the paper forms means you will not be able to track your application online or be able to pay your initial annual fee online: 1. Mail us the following items: the Application for a Teacher s Certification of Qualification form the Consent to a Criminal Record Check form the application fee your identification documents 2. Contact the appropriate institutions and individuals who must send the following documents directly to us: official transcripts of all of your post-secondary studies two Confidential Character Reference for Authorization to Teach in British Columbia forms When we receive your application form, we will create a file for you and email you within five to seven business days to tell you your file number. We will put your file into the evaluation queue and add documents into the file as they arrive. If we receive documents before your application form, we will keep them and then combine them with your application when we receive it. Once an evaluator has reviewed your file, we will send you an email listing any documents that are still missing. If you have questions about your file, you may contact us by telephone or email. Please provide your full name and file number. Email: trb.certification@gov.bc.ca Telephone: 604 660-6060 Toll-free telephone within Canada and the United States: 1 800 555-3684 Once we receive all of the required documents, we will complete an evaluation. Provided you are eligible to receive a certificate, we will: issue your certificate if you have already paid the annual fee, or send you a letter telling you the amount we need to issue your certificate. To expedite your application for a certificate It usually takes the Faculty of Education approximately one month after you have completed the teacher education program to compile all of the necessary information and forward transcripts and recommendations to us. You can ensure that you receive your certificate as quickly as possible by having all of the other required documents and fees sent to us ahead of time. When we receive your transcript and recommendation from the university, we will give your file priority treatment. Provided your file is complete, we may be able to issued your certificate within a week. 4

Required Forms and Documents All documents listed below are required for your file to be evaluated. application form application fee consent to a criminal record check form transcript and recommendation other post-secondary transcripts two character reference forms identification document(s) Additional Documents required for Trades Teachers Journeyperson experience verification Trades Qualification Verification 1. Application for Teacher s Certificate of Qualification form Complete all 4 pages of the form and mail it to us. Include an additional page explaining any yes response to the questions on page 3. If you have previously withdrawn from or failed a practicum or teacher education program, please include a photocopy of your final practicum reports (from both your faculty advisor and school associate). If you have a criminal record, this does not automatically make you ineligible for a certificate. However, you may not qualify if you make false statements or do not tell us about a criminal record. 2. Application Fee You must include the non-refundable application fee with your Application for Teacher s Certificate of Qualification form. For fee amounts and payment options, please visit our website at www.bcteacherregulation.ca and refer to Fee Information for BC Graduates under the Becoming a Teacher tab. 3. Consent to a Criminal Record Check form Please complete the Consent to a Criminal Record Check form and submit it to us with your application form. We will forward your information to the Criminal Records Review Program of the Ministry of Justice. In turn, they will send the results directly to us. Once you become certified, you will need to undergo a criminal record check every five years. Criminal record check results are confidential. We cannot accept previous criminal record checks you have completed, and we cannot provide you with a copy of the results of this criminal record check. 4. Transcript and recommendation from your Faculty of Education Along with your transcript, the Faculty of Education must send us their recommendation that you receive a teaching certificate. Please check with your Faculty of Education to see if this will be done automatically or if you need to take further steps to ensure we receive your transcript and recommendation. 5

Required Forms and Documents 5. Official transcripts of all other post-secondary studies You need to ask each of the other post-secondary institutions, including trades training institutions, that you have attended to mail your official transcripts directly to us. We do not accept transcripts by fax or email. We do not accept transcripts submitted by applicants even if they are sealed or notarized. We require transcripts for the following: coursework for your degree(s), including courses transferred from exchange programs coursework that was required for admission to your teacher education program university-transferred AP and IB credits (transcript from AP, IB, or your high school) Collège d'enseignement général et professionnel (CEGEP) any trades training institutions you have attended (BCIT, VCC, TRU) Some transcripts from post-secondary institutions outside of Canada do not show the degree awarded. In this case, we will require a verified copy of your degree or a letter from the postsecondary institution stating the qualification you received. 6. Confidential Character Reference for Authorization to Teach in British Columbia forms Please complete page 1 of each reference form. You will need to ask two referees who have known you for at least two years to complete page 2 and submit the forms directly to us. Your referees do not need to have observed you in any teaching capacity. However, we will not accept forms completed by referees that are too closely related to you, such as relatives, partners, spouses or equivalents. We will not accept letters of reference as a substitute for the reference forms. 7. Identification document(s) We require a copy of your birth certificate as your primary identification documentation. We also require proof of any other names appearing on your application documents (marriage certificate, divorce certificate or change of name certificate). Photocopies of identification documents must be verified by a notary public or lawyer. We will also accept photocopies that have been verified by any person who has current, valid certification with the BC Ministry of Education. On the photocopy, s/he must write her/his full name, certificate number and signature. If you do not have your birth certificate and you were born in Canada, you need to obtain a replacement from the Vital Statistics department in the province or territory where you were born. you were born outside of Canada, you must have a notary public or lawyer prepare a statutory declaration in which you swear to your date of birth, your full name at birth, your birthplace and the fact that you do not have a birth certificate. You must attach a verified copy of your passport, permanent resident papers or a Canadian citizenship card to the statutory declaration. 6

Required Forms and Documents Sample Statutory Declaration A Statutory Declaration may be made with notary publics or lawyers only. Statutory Declaration To Whom It May Concern I, Johanna Alexandria Doe of 11111 Main Street, Anytown, British Columbia, hereby declare the following statements to be true and correct: 1. That I do not have a birth or baptismal certificate. 2. That the name given to me at birth was Johanna Alexandria Doe. 3. That I was born on the 30th day of September 1900. 4. That my place of birth was Sometown, Anycountry. 5. That I am a citizen and attached hereto as Exhibit "A" is a true copy of my Passport, which expires on 2013-04-19. And I make this solemn declaration, conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath. Declared and signed before me at Anytown in the province of British Columbia this day of AD 20. Signature of Declarant Signature and Seal of Notary Public 7

Required Forms and Documents Additional Documents for Trades Teachers If you completed a teacher education program with a trade as your teachable subject, you will be required to submit the following documents. 8. Journeyperson Experience Verification If you have a recognized trades qualification and 5 or more years of journeyperson and/or trades teaching experience in the last 10 years, you may be eligible for the Trades Certificate. We require verification of your journeyperson and/or trades teaching experience since obtaining your trades qualification (Red Seal, Certificate of Qualification, Journeyman Certificate, etc.). Submit a copy of a signed letter on company letterhead indicating: Your years of employment as a journeyperson/trades teacher and whether you were fulltime or part-time. If you have taught part-time, we need the percentage of full-time or number of days you were employed each year. The nature of your employment such as trades teacher, journeyperson, etc. 9. Trades Qualification Verification You must send a notarized copy of your trades qualification (Red Seal, Certificate of Qualification, Journeyman Certificate, etc.). You can also ask the awarding institution (BCITA, Ontario College of Trades, etc.) to send us a letter stating the qualification and the date they awarded it to you. 8

Additional Information The Freedom of Information and Protection of Privacy Act (FOIPPA) and the Teachers Act The information we collect as part of the application is in compliance with FOIPPA. The Teachers Act authorizes our collection of the personal information we request. Please contact our office if you have questions about the information we request. Regarding your documents All documents we receive as part of your application become the property of the Ministry of Education. We will not return any documents to you, nor will we send them to other individuals and organizations. Leaving BC to teacher in another province or country If you are planning to move to another province or country to teach, you should: apply for a certificate from the Teacher Regulation Branch of the BC Ministry of Education apply for a certificate from the teacher certification authority in the new jurisdiction. To avoid delay, complete and submit the Statement of Professional Standing request form found on our website when you apply to us for your certificate. We will issue your BC Statement of Professional Standing at the same time that we issue your teaching certificate. If you are planning to teach outside of Canada, the education authority in your new jurisdiction may or may not require you to submit your BC teaching certificate or BC Statement of Professional Standing. However, we recommend that you apply for your BC certificate once you have completed your teacher education program. If you wait to apply, the process will take longer and you will need to submit additional documentation. Also, if regulations change, there is the possibility that you may no longer qualify for a BC certificate. The importance of maintaining your BC certificate Once you qualify for a BC certificate, keep your certificate valid by paying the annual fee even if you are not teaching in BC. If you do not pay your annual fee, we will cancel your certificate. You will then have to apply for a new certificate if you wish to teach in BC in the future. We will complete an evaluation based on the regulations in place at that time and you may not qualify. Obtaining your salary category You will need to contact the Teacher Qualification Service (www.tqs.bc.ca) to apply for your salary category. When we issue your teaching certificate, we will automatically forward a copy to TQS on your behalf. 9

Standards for the Education, Competence & Professional Conduct of Educators in British Columbia FOURTH EDITION JANUARY 2012

Introduction The Teachers Act establishes a BC Teachers Council and further provides that the Council create standards for those who hold certificates of qualification issued by the Ministry of Education. Section 10 (1) and (2) of the Act set out the objects of the Teachers Council. The mandate of the council is to establish standards for the education of applicants for certificates of qualification, and also establish standards for the conduct and competence of both certificate holders and applicants for certificates of qualification. Specifically, it establishes standards that a person must meet in order to be issued and to maintain a certificate of qualification. These include standards relating to:» Training & qualifications requirements for applicants & certificate holders» Competence» Conduct In carrying out its objects, the council must exercise its powers and perform its duties under this Act in the public interest. The intent of the Act is that, in making standards, the Teachers Council must consider the needs of the public, especially of the students who are the clients of teachers, ahead of the interests of certificate holders. This means that the standards for teachers are to be established for the benefit of students, their parents and the society as a whole. The Purpose and Meaning of the Standards in Practice Standards are not detailed descriptors of teaching competency or conduct. They are statements of principle upon which the detail can be built. Standards should be succinct and convey to the reader an overall sense of the work that teachers do (competencies) and the ways in which they behave (conduct). The Standards for the Education, Competence and Professional Conduct of Educators in British Columbia (Standards) were adopted in 2008 by the BC College of Teachers and, through the Teachers Act, have been continued as the standards for certificate holders until such time as they might be revised by the Teachers Council. The Standards are intended to honour and advance the work of educators by highlighting the complex and varied nature of educators work. They articulate the knowledge, skills and attitudes that educators shall possess as well as the responsibilities that accrue to them as certified educators who hold the public trust. In doing so, the Standards contribute to a safe and high-quality learning environment for students and provide a basis for attaining and assessing both competency and conduct. Taken together, the Standards define the attributes and expertise that educators bring to bear for the benefit of children and society. As a tool for the public good, the Standards are intended to support the goals of our society by helping to support the education of citizens to live productive and fulfilled lives. Educators who embody these Standards must be able Definitions aboriginal includes all Aboriginal peoples, especially First Nations, Inuit & Métis authority a society incorporated under the Society Act, or a corporation incorporated under the Business Corporations Act or a private Act, or a person designated, by regulation, as an authority that operates or intends to operate an independent school

to relate intellectually, pedagogically and ethically with children as they teach the specific subjects and curriculum of BC. Standards are a way of communicating to certificate holders and the public the description of the work of educators what they know, what they are able to do, and how they comport themselves as they serve the public. The Standards provide the foundation and stability on which educators can grow, articulating both the values and characteristics that distinguish the work of educators. Certificate holders enter into a contract with the public that provides them with a level of autonomy in return for an agreement that the educator will place the interests of the public above individual interests. Educators agree to be accountable to the public, and the Standards serve as a touchstone for this responsibility. Even the most eminent and competent educators will continue throughout their careers to learn about and build their repertoires in pedagogy and subject area knowledge. Indeed, standards serve both as ideals to which educators aspire and expectations that can be reasonably held. One critical consideration that often accompanies the development of standards is the question of how they will be used in practice. The practice of education is an ongoing journey of growing understanding and developing skills. The notion that an educator can attain perfection in practice flies in the face of the notion of continual learning and suggests that meeting a standard can be relative. The question should not be Has the Standard been met? but To what extent has the Standard been met for the particular context in which the educator is preparing or working? A deficit in a single standard is not necessarily a fatal flaw that destroys professional competence, though in certain substantive circumstances it may be. A demonstration of competence will, by necessity, be different for a beginning teacher than for a seasoned veteran. Commitment to the Standards The Standards should be a positive force for educators that will honour their work and benefit the children and people of BC through supporting student academic success and social development and by developing an informed citizenry. As new educators become certified to teach in BC, they will be required to sign a commitment that their practice will be governed by the ethics and principles as outlined in the Standards. By agreeing to abide by the Standards, an educator makes a commitment to the public in which parents can confidently send their children into an educator s care. The Standards have the following applications: Establish commonly held standards of practice and conduct that guide teacher education, teaching practice and ongoing professional growth Communicate to the public the standards that educators hold and Establish a framework that guides the Teachers Council and the Ministry of Education in setting requirements and making decisions related to teacher education programs, certification of applicants, fitness to practice and discipline. board a board of school trustees constituted under the School Act community all those who live in an area served by a school or school district competence having the knowledge & skills to carry out the duties of an educator conduct the actions or omissions of an educator including such actions or omissions both within and outside of an educator s professional role educator a person who holds, has held, or is an applicant for a certificate of qualification from the Ministry of Education minor child or youth under the age of 19 parent (in respect of a student or of a child): the guardian of the person of the student or child the person legally entitled to custody of the student or child the person who usually has the care and control of the student or child student a person enrolled in a K-12 educational program provided by a board of education, authority or First Nations School and for whom an educator has responsibility.

Ministry of Education Teacher Regulation Branch 400-2025 W. Broadway Vancouver, BC V6J 1Z6 Canada t 604 660 6060 toll free 1 800 555 3684 f 604 775 4859 bcteacherregulation.ca 1. Educators value and care for all students and act in their best interests. Educators are responsible for fostering the emotional, esthetic, intellectual, physical, social and vocational development of students. They are responsible for the emotional and physical safety of students. Educators treat students with respect and dignity. Educators respect the diversity in their classrooms, schools and communities. Educators have a privileged position of power and trust. They respect confidentiality unless disclosure is required by law. Educators do not abuse or exploit students or minors for personal, sexual, ideological, material or other advantage. 2. Educators are role models who act ethically and honestly. Educators act with integrity, maintaining the dignity and credibility of the profession. They understand that their individual conduct contributes to the perception of the profession as a whole. Educators are accountable for their conduct while on duty, as well as off duty, where that conduct has an effect on the education system. Educators have an understanding of the education system in BC and the law as it relates to their duties. 3. Educators understand and apply knowledge of student growth and development. Educators are knowledgeable about how children develop as learners and as social beings, and demonstrate an understanding of individual learning differences and special needs. This knowledge is used to assist educators in making decisions about curriculum, instruction, assessment and classroom management. 4. Educators value the involvement and support of parents, guardians, families and communities in schools. Educators understand, respect and support the role of parents and the community in the education of students. Educators communicate effectively and in a timely manner with parents and consider their advice on matters pertaining to their children. 5. Educators implement effective practices in areas of classroom management, planning, instruction, assessment, evaluation and reporting. Educators have the knowledge and skills to facilitate learning for all students and know when to seek additional support for their practice. Educators thoughtfully consider all aspects of teaching, from planning through reporting, and understand the relationships among them. Educators employ a variety of instructional and assessment strategies. 6. Educators have a broad knowledge base and understand the subject areas they teach. Educators understand the curricular, conceptual and methodological foundations of education and of the subject areas they teach. Educators must be able to communicate effectively in English or French. Educators teach students to understand relevant curricula in a Canadian, Aboriginal, and global context. Educators convey the values, beliefs and knowledge of our democratic society. 7. Educators engage in career-long learning. Educators engage in professional development and reflective practice, understanding that a hallmark of professionalism is the concept of professional growth over time. Educators develop and refine personal philosophies of education, teaching and learning that are informed by theory and practice. Educators identify their professional needs and work to meet those needs individually and collaboratively. 8. Educators contribute to the profession. Educators support, mentor or encourage other educators and those preparing to enter the profession. Educators contribute their expertise to activities offered by their schools, districts, professional organizations, post-secondary institutions or contribute in other ways. p r i n t e d i n c a n a da

Application for Teacher s Certificate of Qualification PLEASE MAIL THIS FORM (ORIGINAL SIGNATURE IS REQUIRED) File # (if assigned): M F Title (Mr., Ms., etc.) Date of Birth (YYYYMMDD) Gender Given Names Surname Used Given Name Birth Surname Other Previous Surname Street Address/P.O. Box City/Town Province/State Country Postal Code/Zip Code Primary Email Address Home Phone Number Mobile Phone Number (include area code) Secondary Email Address Work Phone Number (include area code) Please indicate how you would like to receive updates about the status of your application. Note that if you do not specify, we will email updates to you using your primary email address. Email Mail If you have been newly hired in BC, please indicate whether in: Public School District Number Independent (non-public) School School District or Independent School Name City / Town Fulltime Parttime On Call Start Date (YYYYMMDD) FOR OFFICE USE ONLY Fee Enclosed: Yes No

Application for Teacher s Certificate of Qualification Page 2 ACADEMIC QUALIFICATIONS Secondary Education: Name of Diploma or Certificate Location Year Completed Y E A R Undergraduate Degree: Name of Degree Year Completed Y E A R Name of Institution Location Teacher Education: Name of Degree Year and Month Completed Y E A R M M Name of Institution and Location Grade Level/Teaching Subject Areas Was any part of your Teacher training completed by distance education or online education? Yes No Graduate Degree: Name of Degree Year Name of Institution and Location Trades Qualifications: 1. Name of Qualification Year Name of Awarding Institution and Location 2. Name of Qualification Year Name of Awarding Institution and Location All other Post-Secondary Institutions attended, including Trades training: 1. Name of Institution and Location Year 2. Name of Institution and Location Year 3. Name of Institution and Location Year 4. Name of Institution and Location Year Please ensure that the above institution(s) will mail an official transcript to the Teacher Regulation Branch. Official transcripts are also required from all other post-secondary institutions attended even if the credit has been transferred to another institution. We do not accept transcripts from applicants. Please list all jurisdictions where you hold, or have held, valid teaching certification. 1. 2. 3. 4.

Application for Teacher s Certificate of Qualification Page 3 EMPLOYMENT EXPERIENCE For this section, begin with the most recent; label T for teaching experience, E for other educational work, P for practica, J for journeyperson experience, and N for not related to teaching. L a b e l Dates Location (School or Employer, City, Country) Grades and Subject(s) Taught (or description of employment)

Application for Teacher s Certificate of Qualification Page 4 PERSONAL INFORMATION All questions in this section must be answered. For every affirmative answer (yes), please attach a detailed written explanation, including dates and locations, and supporting documents if applicable. Yes No 1. Have you ever applied anywhere for authorization and/or certification to teach and had your application rejected? Yes No 2. Have you ever for any reason other than failure to pay fees voluntarily surrendered your authorization and/or certification to teach? Yes No 3. Have you ever, in advance of an investigation or disciplinary proceeding, either voluntarily or involuntarily restricted your teaching practice? Yes No 4. Have you ever been disciplined by an employing school district or independent authority, a university (as a student), or other educational organization? Yes No 5. Have you ever been found guilty of professional misconduct or been found to be incompetent or incapacitated as a member of the teaching or other profession? Yes No 6. Have you ever agreed to a settlement or a resignation to avoid any proceeding or disciplinary action with respect to your professional conduct, competence or capacity? Yes No 7. Has there ever been, or is there now, an investigation or proceeding in regards to your professional conduct, competence or capacity as an educator in another jurisdiction, or as a member of another profession? Yes No 8. Have you ever failed or voluntarily withdrawn from a teacher education program or from a practicum? Yes No 9. Have you ever been asked by a Faculty of Education to withdraw from a teacher education program or practicum? Yes No 10. Do you have any medical (physical or mental) condition that could affect your fitness to teach? Yes No 11. Have you ever been charged (including stays of proceeding), convicted of or given an absolute or conditional discharge or received a pardon or a record suspension on a criminal offence? Yes No 12. Are there any outstanding criminal charges against you? Yes No 13. Has there ever been a peace bond or restraining order issued against you? Yes No 14. Are you currently the subject of a criminal investigation? Yes No

Application for Teacher s Certificate of Qualification Page 5 DECLARATION OF PROFESSIONAL COMMITMENT 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, educational institution, police force, military authority, governing body or other organization enquired of under this authorization to provide the Teacher Regulation Branch all relevant information or documents requested by the Branch. I accept the responsibility for advising the Teacher Regulation Branch, in writing, of any change to any information contained in this application. I understand that if my suitability to teach is in question, the Director of Certification may conduct an investigation into my application. I understand that any information related to my conduct that occurred before my certificate was issued may be reviewed by the Director of Certification and my certificate may be rescinded based on this information. I understand that information related to my certification status may be shared with employers and education authorities and provided to the public on the online registry as per section 80 of the Teachers Act. I have read and I understand the Standards for the Education, Competence and Professional Conduct of Educators in British Columbia and/or the Independent School Teacher Conduct and Competence Standards. I solemnly declare that I shall uphold these standards in my professional practice. Applicant Signature Date Printed Name CERTIFICATE HOLDER RESEARCH REGISTER From time to time, the Teacher Regulation Branch receives requests from researchers to survey certificate holders or to invite them to participate in research projects. The Branch has established a research register for those certificate holders who would be willing to be contacted for the purpose of research. All contact is between the Branch and the certificate holder. Researchers are not permitted to contact certificate holders directly. In the event that we contact you about participating in a research project, you will have an opportunity to opt in or out at that time there is no obligation on your part to continue if you choose not to. If you are willing to put your name on the registry, please check the box below. I hereby agree to make my name available to the Teacher Regulation Branch for the purpose of research. SUBMISSION OF AN APPLICATION THAT IS MISLEADING OR FALSE IN WHOLE OR IN PART MAY LEAD TO DENIAL OF CERTIFICATION OR DISCIPLINARY ACTION BY THE MINISTRY OF EDUCATION. The information contained on this application form is collected under the authority of the Teachers Act and is necessary for certification purposes. The Ministry of Education may disclose some information in accordance with the provisions of the Freedom of Information and Protection of Privacy Act. Questions regarding the collection of this information should be directed to our office. Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859 August 2015

Consent to a Criminal Record Check For working with children and/or vulnerable adults Schedule Type: B APPLICANT TO/CERTIFICATE HOLDER WITH MINISTRY OF EDUCATION Pursuant to the Criminal Records Review Act, all applicants to and certificate holders with the Ministry of Education must undergo a criminal record check, which includes a vulnerable sector check, every five years. The Teacher Regulation Branch of the Ministry of Education facilitates this requirement by collecting and submitting your consent to the Criminal Records Review Program of the Ministry of Justice who will perform the criminal record check. IMPORTANT: Please complete this form using a dark ink pen, printing clearly and carefully. There may be a delay in processing if the form is submitted incomplete or incorrectly, or if information cannot be read. When the form is completed and signed by you, please forward it to the Teacher Regulation Branch by mail, fax (604 775-4859), or as a scanned email attachment (trb.certificateservices@gov.bc.ca). PART 1 APPLICANT/CERTIFICATE HOLDER INFORMATION File or Certificate Number (if assigned): Surname: Full First: Full Middle: Birth Date: Gender: Male Female Birth Place: (yyyy/mm/dd) (City, Province/State, Country) OTHER NAMES USED OR HAVE USED: (e.g. alias, maiden name, birth name, or previous married name) Surname: First: Middle: Surname: First: Middle: Surname: First: Middle: Mailing Address: City: Province: Country: Postal Code: Contact Phone: ( ) BC Driver s Licence Number: DL (Please leave blank if you don t have a BC Driver s Licence.) Email Address: PART 2 ORGANIZATION INFORMATION For Office Use Only Employer Name: Teacher Regulation Branch, Ministry of Education ID Number: 15/606188 Mailing Address: 400 2025 W Broadway City: Vancouver Province: BC Country: Canada Postal Code: V6J 1Z6 Office Phone: 604 775-4880 Fax: 604 775-4859 CONSENT FOR RELEASE OF INFORMATION AND ACKNOWLEDGEMENTS I authorize the Ministry of Education to submit my information to the Criminal Records Review Program on an ongoing basis every 5 years. I understand that I may withdraw this consent at any time in the future and that the Teacher Regulation Branch of the Ministry of Education will notify me when my information is submitted. I have read and understand the Consent for Release of Information and Acknowledgements on the reverse. I hereby consent to the terms as indicated by my signature below. Signature: Date Signed: (yyyy/mm/dd) Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Consent to a Criminal Record Check For working with children and/or vulnerable adults Page 2 CONSENT FOR RELEASE OF INFORMATION AND ACKNOWLEDGEMENTS PURSUANT TO THE B.C. CRIMINAL RECORDS REVIEW ACT I hereby consent to a check for records of criminal charges and convictions to determine whether I have a conviction or outstanding charge for any relevant or specified offence(s) under the Criminal Records Review Act. I hereby consent to a check of all available law enforcement systems, including any local police records. I hereby consent to a vulnerable sector search* to check if I have been convicted of and been granted a pardon for any sexual offences of the Criminal Records Act. I understand a criminal record check under the Criminal Records Review Act is required at least once every five years. I hereby authorize the release to the Deputy Registrar any documents in the custody of the police, the court and crown counsel relating to an outstanding charge or conviction of any relevant or specified offence(s) as defined under the Criminal Records Review Act. Where the results of this check indicate that a criminal record or outstanding charge for a relevant or specified offence(s) may exist, I agree to provide my fingerprints to verify any such criminal record. The Deputy Registrar will notify me and my organization that I have an outstanding charge or conviction for any relevant or specified offence(s) and the matter has been referred to the Deputy Registrar; The Deputy Registrar will determine whether or not I present a risk of physical or sexual abuse to children and/or physical, sexual or financial abuse to vulnerable adults as applicable. The Deputy Registrar s determination will be disclosed to my organization and it will include consideration of any relevant or specified offence(s) for which I have received a pardon. If I am charged with or convicted of a relevant or specified offence(s) at any time subsequent to the criminal record check authorized herein, I further agree to report the charge or conviction to my organization and provide my organization, in a timely manner, with a new signed Consent to a Criminal Record Check form. * Go to the RCMP website for additional details on vulnerable sector checks: www.rcmp-grc.gc.ca/cr-cj/vulner/index-eng.htm. FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT (FOIPPA): The information requested on this form is collected under the authority of the Criminal Records Review Act section 4(1) and section 26(c) of the Freedom of Information and Protection of Privacy Act (FOIPPA). The information provided will be used to fulfil the requirements of the Criminal Records Review Act for the release of criminal records information and is in compliance with the FOIPPA. If you have questions about the collection of your personal information, please contact the Policy Analyst, Criminal Records Review Program, PO Box 9217 Stn Prov Govt, Victoria, BC V8W 9J1 or by phone at 1 855 587-0185. Visit the Criminal Records Review Program online at: www.pssg.gov.bc.ca/criminal-records-review. May 2014 Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Credit Card Payment Authorization Form Please use this form to authorize the use of a credit card for a fee payment. (Note: Certificate holders who are in default of paying the annual practice fee are subject to the addition of a $30 late fee if the fee is received between June 1 and June 30, and a $60 late fee if the fee is received between July 1 and October 31.) Applicant s/certificate Holder s name: File/Certificate #: Name of individual, agency or business as it appears on the credit card (please print): I authorize use of the credit card indicated to pay the fee(s) for the applicant/certificate holder named above. Total Payment Authorized $ Date (YYYY/MM/DD) In the event that we need to get in touch with you, please provide us with your contact information: Address: Home Phone: Work Phone: Email address: AUTHORIZATION FOR CREDIT CARD USE American Express Visa Master Card Card Number Expiry (MM/YY) / I authorize the Ministry to charge (Amount in CDN$) $ to the credit card number shown above. Printed name as it appears on credit card Cardholder s signature Please note: The credit card information provided on this form will not be retained. Upon authorization of the payment request, all credit card information will be destroyed. Credit card data should not be emailed. Please fax to the Teacher Regulation Branch at 604 775-4859 or mail to the address below. The easiest and fastest way to pay your annual fee by credit card is by entering the secure Certificate Holders Area on our website. May 2015 Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Confidential Character Reference for Authorization to Teach in British Columbia Page 1 Applicant, please complete this page. I, Full given names Applicant s legal surname Birth Surname: Date of Birth: YYYYMMDD Previous Surnames: Street Address/P.O. Box City/Town Province/State Country Postal Code/Zip Code hereby consent the following referee: (Please print referee s name) to provide the Ministry of Education with this confidential character reference as part of my application for authorization to teach in BC; and I acknowledge that this confidential character reference is not a teaching report. Date: Signature of Applicant: Notes: This two-page character reference form is to be provided by the applicant to a referee who shall complete page 2. The referee must not be a relative, partner or spouse (or equivalent) of the applicant and must have known the applicant for a minimum of two years. The referee must send the form directly to the Ministry of Education by mail, fax or scanned email (trb.certification@gov.bc.ca). This character reference will not be accepted as a teaching report. Delay in the receipt of this form will result in delay in the processing of the application. Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Confidential Character Reference for Authorization to Teach in BC Page 2 Referee, please complete this page and send it directly to the Ministry of Education by mail, fax or scanned email (trb.certification@gov.bc.ca). Applicant s Name: 1. How long have you known this applicant? A referee must have known the applicant for a minimum of two years. 2. In what capacity have you known this applicant? A referee must not be a relative, partner or spouse (or equivalent) of the applicant. 3. Describe situation(s) in which you have observed the applicant working with children or youth. If you have not observed the applicant working with children or youth, what characteristics and/or qualities have you seen the applicant exhibiting that would be valuable in working with young people? 4. Explain why you consider the applicant to be a fit and proper person to be working with students. 5. Do you have any reason to believe the applicant should not be granted authorization to teach? No Yes. If Yes, please explain. Name of Referee: (Please print full name) To the best of my knowledge the above information is complete and correct. Signature of Referee: Date: Address: Telephone: (H) (W) Should the applicant, under the Freedom of Information and Protection of Privacy Act, request a copy of this reference, do you consent to its release? No Yes Delay in receipt of this form will result in delay in the processing of the application. This is a character reference only and may not be used as a teaching report or professional evaluation. Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Confidential Character Reference for Authorization to Teach in British Columbia Page 1 Applicant, please complete this page. I, Full given names Applicant s legal surname Birth Surname: Date of Birth: YYYYMMDD Previous Surnames: Street Address/P.O. Box City/Town Province/State Country Postal Code/Zip Code hereby consent the following referee: (Please print referee s name) to provide the Ministry of Education with this confidential character reference as part of my application for authorization to teach in BC; and I acknowledge that this confidential character reference is not a teaching report. Date: Signature of Applicant: Notes: This two-page character reference form is to be provided by the applicant to a referee who shall complete page 2. The referee must not be a relative, partner or spouse (or equivalent) of the applicant and must have known the applicant for a minimum of two years. The referee must send the form directly to the Ministry of Education by mail, fax or scanned email (trb.certification@gov.bc.ca). This character reference will not be accepted as a teaching report. Delay in the receipt of this form will result in delay in the processing of the application. Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859

Confidential Character Reference for Authorization to Teach in BC Page 2 Referee, please complete this page and send it directly to the Ministry of Education by mail, fax or scanned email (trb.certification@gov.bc.ca). Applicant s Name: 1. How long have you known this applicant? A referee must have known the applicant for a minimum of two years. 2. In what capacity have you known this applicant? A referee must not be a relative, partner or spouse (or equivalent) of the applicant. 3. Describe situation(s) in which you have observed the applicant working with children or youth. If you have not observed the applicant working with children or youth, what characteristics and/or qualities have you seen the applicant exhibiting that would be valuable in working with young people? 4. Explain why you consider the applicant to be a fit and proper person to be working with students. 5. Do you have any reason to believe the applicant should not be granted authorization to teach? No Yes. If Yes, please explain. Name of Referee: (Please print full name) To the best of my knowledge the above information is complete and correct. Signature of Referee: Date: Address: Telephone: (H) (W) Should the applicant, under the Freedom of Information and Protection of Privacy Act, request a copy of this reference, do you consent to its release? No Yes Delay in receipt of this form will result in delay in the processing of the application. This is a character reference only and may not be used as a teaching report or professional evaluation. Ministry of Education Teacher Regulation Branch Mailing Address: Telephone: 604 660-6060 400-2025 West Broadway Toll Free: 1 800 555-3684 Vancouver BC V6J 1Z6 Facsimile: 604 775-4859