Application for MEPI Certification
Applicant's Name - as it should appear on your certificate *
Your answer
Mailing address to send your certificate *
Your answer
Best phone number to reach you *
Your answer
Applicant's email address *
Your answer
Internship Site School Name *
Your answer
Internship Site School Address *
Your answer
Internship Site email address *
Your answer
Your Supervising Director's Name *
Your answer
Full Certification Requirements Completed - to be completed by TEP Course Director *
Completed
NA
Academic Instruction
Observations
Child Study (EC & EL)
Adolescent study
Demonstration Checklist
Classroom Practicum
Manuals
Workshops / Seminars attended
Original Projects
Book Reports
Parent Teacher Conferences - observed
e-Open Forum submission
TEP Course Director's Name who is verifying this information *
Your answer
Date of 1st on-site visit *
MM
/
DD
/
YYYY
Date of 2nd on-site visit *
MM
/
DD
/
YYYY
Date of 3rd on-site visit *
MM
/
DD
/
YYYY
Academic Only Certification requirements to be completed by TEP Course Director *
Completed
NA
Academic Instruction
Observations
Child Study (EC & EL)
Adolescent study
Demonstration Checklist - presented only
Manuals
Workshops / Seminars attended
Book Reports
e-Open Forum Submission
This application is for the following program level for Certification as a Classroom Director *
For all Elementary and Adolescent certificates *
Required
Program Directors - please submit the following documents digitally and send via email *
Will email digital copy
This form was completed on-line
Has been verified
1st & 3rd Supervising Director's evaluations
Completed Demonstration Checklist
Letter of Recommendation from Program Director
Verify the Internship site evaluation has been completed
Verify the TEP evaluations has been completed -
The MEPI office has a copy of the Supervising Director's Montessori certificate
Verify Elementary documents are in place
Verify an eOpen Forum submission has been sent
Please check all that apply *
Required
All supporting documents should be sent digitally to:
MontessoriEPI@gmail.com

MEPI - PO Box 6, Smithville, Indiana 47458 ~ office: 812-824-6366 fax: 888-708-2470

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