TDC Initial Educator-Traditional Add-on Program Entry Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This information is collected to help you start the TDC information form that you will be required to fill out later in the application process and to help facilitate your program application. After completing the form, you will receive an email with a Google Document to complete.

Legal First Name *

Preferred First Name *

Middle Name *

Last Name *

DPI Entity Number *

If you haven't applied before, you may not have one. In that case, type "None". If you do have one, you can find it by logging in to https://elo.wieducatorlicensing.org/ or searching for your name at https://dpi.wi.gov/licensing/license-lookup

Personal Email Address *

Work Email Address *

Home or Cellphone Number *

Please enter your phone number in the format 123-456-7890

Phone Number Type *

Landline

Cell Phone

Work Phone Number *

Please enter your phone number in the format 123-456-7890

Select the license(s) you desire. *

Only choose more than one license if you are pursuing a bilingual/bicultural supplemental license

1777 - Early Childhood Regular Education - Birth to 3rd Grade

1809 - Early Childhood Special Education - Birth to 3rd Grade

2088 - Regular Education Grades K-9

2801 - Cross-Categorical Special Education - K-12

1395 - English as a Second Language - K-12

1365 - Spanish - K-12

1400 - Mathematics - Grades 4-12

1023 - Bilingual/Bicultural

Other:

Required

Are you currently employed under a teacher contract OR do you plan to be employed under a teacher contract by next school year? *

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of Cooperative Educational Service Agency 7.

Does this form look suspicious? Report

Forms