The Oregon TSPC C-1 form serves as the application for an educator license or registration in the state of Oregon. This form requires individuals to provide personal information, educational history, and professional experience as part of the licensing process. Completing the form accurately is essential, as any false information may lead to denial or revocation of the license.
The Oregon TSPC C-1 form is a crucial document for individuals seeking to obtain or renew an educator license or registration in the state of Oregon. This application form, issued by the Teacher Standards and Practices Commission, serves multiple purposes, including applying for a new type of license, adding endorsements, reinstating an expired license, or registering with a charter school. Before filling out the form, applicants are advised to carefully read the accompanying instructions to ensure accuracy and completeness. The form requires personal information such as the applicant's full legal name, contact details, date of birth, and Social Security Number, which is necessary for child support enforcement and state income tax collection. Additionally, applicants must disclose their educational background, including degrees earned and any previous licenses held in Oregon or other states. The C-1 form also emphasizes the importance of professionalism in education, outlining a commitment to ethical conduct and the welfare of students. Applicants must attest to the truthfulness of their information, as providing false details can lead to denial or revocation of their license. Completing this form is an essential step for educators dedicated to fostering a positive and effective learning environment.
Teacher Standards and Practices Commission
250
Division St NE
Salem, OR 97301
Email: contact.tspc@oregon.gov
Phone (503) 378-3586;
Fax
(503) 378-4448
Web Site: www.oregon.gov/tspc
Application for Educator License or Registration – Form C-1
Before completing this form please read the instructions carefully. Once complete, sign the application, attesting to the accuracy of information provided. Providing false information on your application is grounds for the Commission to deny your application or revoke your license or registration.
Please write legibly and use black or blue ink. Please be sure to provide your full legal name.
LAST NAME
FIRST NAME
MIDDLE NAME
PREVIOUS
Current Mailing Address
Check this box if new address City, State and Postal Code
Male
Female
Home/Cell phone number Work phone number
Date of Birth
Gender
Social Security Number
E-mail Address
As part of your application for an initial or renewed license or registration, you are required to provide your Social Security Number (SSN) for purposes of child support enforcement (ORS 25.785 and 42 USC § 666(a)(13)) and state income tax collection (ORS 305.385 and 42 USC § 405(c)(2)(C)(i)).
The Commission may also disclose your SSN to the interstate clearinghouse for educators if your Oregon license or registration is subject to discipline for unprofessional conduct (ORS 342.143 and 342.175 to 190).
Ethnic and Race Status: (Optional - for statistical purposes only)
1.
Which race or ethnicity best describes you?
(You may check more than one)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino or other Spanish Origin
Native Hawaiian or Other Pacific Islander
Multi-ethnic
White
Other
2.
If you checked above that you are an American Indian, please check here if you are a
member of one of the nine recognized tribes in Oregon.
3.
Is English your first language?
Yes
No
Previous Educational Licenses, Registrations, and Certifications: (Required information)
1.Have you held any type of Oregon educational license previously? Yes No
2.Have you held any license valid for full-time educational work (to include substitute teaching) in another state? Yes No
3.If yes to #2, in which other state or states are/were you licensed? ______________________
4.When did you receive your first unrestricted license in another state? _________________
5.Under what name(s) (in Oregon or another state) were you previously licensed? __________________
PURPOSE FOR FILLING OUT THIS APPLICATION
Apply for new type of license (administrator, counselor, etc.): _______________________________
Add endorsement(s): _____________________________
Reinstate an expired license: _________________________________
Renew an existing license: _______________________________
Charter School Registration:
First time application or
Renewal
Teacher or
Administrator
Other: ______________________________
ACADEMIC DEGREES & EDUCATOR PROGRAMS COMPLETED
List all institutions from which you have earned a degree, unless already on file with TSPC. Also list all teacher, counselor, psychologist, or administrator programs you have completed, regardless of any connection to a degree. If you have not yet completed a degree or educator licensure program, please state “NONE.”
1.______________________________ ___________________________ ___________________________ ________________________
College or University
City & State
Major/Program
Degree earned (BS, MAT, etc.)
2.______________________________ ___________________________ ___________________________ ________________________
3.______________________________ ___________________________ ___________________________ ________________________
4.______________________________ ___________________________ ___________________________ ________________________
5.______________________________ ___________________________ ___________________________ ________________________
Please Note: For some license applications, you will be required to submit official transcripts to verify coursework. Please see renewal and application instructions for individual licenses to determine what you need to submit.
EXPERIENCE AS PROFESSIONAL EDUCATOR
List all of your employment experience in the last five years as a teacher, school counselor, psychologist, social worker or administrator to TSPC. If none, state “NONE”. If you worked as a substitute (full or restricted), please indicate.
Dates
Name of School
Grade
Contracted
Substitute
From:
To:
Level(s)
½ time or more?
experience?
Statement of Professionalism
Adopted by the Oregon Teacher Standards and Practices Commission on
April 25, 2013
As educators, we belong to a profession that serves Oregon K-12 students, schools, our communities and the public good. We aspire to a professional standard of conduct that goes beyond merely complying with ethical rules. Professionalism is the courage to care about and act for the benefit of our children, our students, our peers, our careers and the public good.
Because we are committed to professionalism, we will conduct ourselves in a way consistent with the following principles in dealing with our students, our peers, our supervisors, and the public.
Specifically, I will:
Attest to all that I have good moral character.
Put the welfare of children first and will do no physical or emotional harm to a child.
Conduct myself with integrity.
Avoid all forms of discrimination against my students and all others.
Commit to academic equity in learning for all of my students.
Commit to educational excellence in all I do.
Respect my colleagues.
Commit to lifelong professional development to improve my skills and the opportunities for my students and the profession.
Resolve disputes with students with compassion, empathy and patience.
Be a role model for my students.
Never violate the student-educator boundaries critical for student achievement and success.
I hereby certify that the information submitted on or relating to this form is true and correct and grant the Commission permission to check civil or criminal records to verify any statement made on this application.
_________________________________________
_____________________________
Signature of Applicant/Educator
Date
Printed Signature
CHARACTER QUESTIONS
Please carefully read the “Instructions for Answering Character Questions” before answering. You must answer either “yes” or “no” to each of the following questions; any other response will result in your application being considered incomplete. All "yes" answers must be fully explained in writing on a separate piece of paper and the explanations must be signed and dated by you. You must also include certified true copies of all legal documents, including court records.
Have you ever left any educational or school-related employment, voluntarily or involuntarily, while
the subject of an inquiry, review or investigation of alleged misconduct? Have you ever left
educational or school-related employment when you had reason to believe an investigation for
misconduct was underway or imminent?
Are you currently the subject of an inquiry, review or investigation for alleged misconduct or
alleged violation of professional standards of conduct by either an employer or a licensure
agency?
Have you ever been placed on leave by your employer for any alleged misconduct?
4.
Have you ever had any adverse action taken on a professional certificate, license or charter
school registration? Have you ever been placed on probationary status for alleged misconduct
while holding a professional license, certificate, registration, or credential?
5.
Have you ever been denied any professional license for which you applied or granted a
professional license on a conditional or probationary basis for any alleged misconduct?
6.
Have you ever surrendered a professional license of any kind before its expiration?
7.
Have you ever been disciplined by any public agency responsible for licensure of any kind,
including but not limited to educational licensure?
8.
Have you ever been convicted or been granted a diversion or conditional discharge by any court
for any: (a) Felony; or (b) Misdemeanor; or (c) Major traffic violation including but not limited to:
driving under the influence of intoxicants or drugs; reckless driving; fleeing from or attempting to
elude a police officer; driving while your license was suspended, revoked or used in violation of
any license restriction; or failure to perform the duties of a driver or witness at an accident?
9.
Have you ever been arrested or cited for any offense listed in section (8) above which is still
pending in the courts? This includes any diversion, conditional discharge or postponed
adjudication that has not been dismissed by the courts at the time this application is signed.
10. Have you ever had any civil judgment or other court order, including but not limited to a restraining
order, entered against you resulting from allegations of abuse, assault, battery, harassment,
10.
intimidation, neglect, stalking, or other threatening behavior toward other persons?
Check here if you provided an explanation for any “yes” answer with a prior application. Please know that any new incident that occurred since your last application requires that you answer “yes” and include a full written explanation, along with applicable court documents.
Your Signature and the Date: Under penalty of false swearing, I declare that the information in this application is true, correct, and complete. Providing false information is grounds for the Commission to deny my application or revoke my license or registration. I also grant the Commission permission to check civil or criminal records to verify any statement made on this application.
Signature of the Applicant
Date*
*This application must be signed and dated within 60 days prior to the date the application is received by TSPC.
YOU MUST PRINT AND MAIL THIS FORM DIRECTLY TO: TSPC
250 Division St. NE
Salem, Oregon 97301
Kicker Check Oregon - By checking the appropriate boxes, filers ensure their payments are correctly classified.
The Illinois Residential Lease Agreement is essential for safeguarding both landlords and tenants, as it establishes clear terms and conditions regarding rental expectations. For those interested in creating their own agreement, the process can be initiated by accessing the necessary resources, such as the Illinois PDF Forms, which provide a convenient way to obtain the required documentation.
Oregon Statement - Personal information section requires detailed disclosures, including aliases and information on dependents.