SOUTHERN UNION APPLICATION FOR CERTIFICATION

TEACHER: Please complete this form and mail to address listed at the bottom of the form.

PROCEDURE: This application, accompanied by an official transcript of all college and graduate work taken

and evidence of your work experience must be submitted to the Southern Union Conference Office of

Education. Your certificate will be issued by the Union Conference Office of Education in harmony with the

requirements set forth in the current NAD certification policies.

I hereby make application for the following certificate(s):

_____A. Basic _____C. Professional _____E. Designated Subjects/Services

_____B. Standard _____D. Administrator _____F. Conditional

Endorsement(s) desired: _____________________ ______________________ _________________________

Name: _____________________________________________________________________________________

First Middle Maiden Last

Address: ___________________________________________________________________________________

Phone Number:_______________________NAD Teacher ID #_______________ check if new address

Birthdate: ______________________________ Email: _____________________________________________

Check only if renewing or reinstating certification, then sign and date at the bottom of form.

EDUCATION HISTORY: (If additional history, add on page 2)

COLLEGE / UNIVERSITY

DEGREE

MAJOR

MINOR

COMPLETION

YEAR

CERTIFICATION INFORMATION:

Number of years of teaching experience: ______ Denominational:______ Public:_______

What denominational teaching certificate do you now hold? _______________________________________

Date Issued:_______________________ By Whom? _________________________________Union.

Name of last Union/Conference you taught for? ___________________________________________________

If now teaching, at what school?________________________________Conference:______________________

This application indicates that I am an active member of the Seventh-day Adventist Church and certify that it is my intention

to subscribe to and teach within the framework and philosophy of the Seventh-day Adventist Church as outlined in the General

Conference Working Policy and the employment policies of the Southern Union Conference Education Code.

Signature: _______________________________________ Date: _________________________________

Southern Union Office of Education: 302 Research Dr. Norcross, GA 30092 * 770-408-1800 * F 770-408-1801 * www.adventistedge.com

We will request your file and transcripts be sent to us from former Union. Please request official transcript from classes not sent to former registrar.