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Content Overview

The Oregon TSPC C-1 form is an essential document for educators seeking to apply for or renew their educator license or registration in the state. This application form, managed by the Teacher Standards and Practices Commission, requires applicants to provide comprehensive personal information, including their full legal name, contact details, and Social Security Number. The form emphasizes the importance of accuracy, as any false information can lead to the denial or revocation of an application. Applicants must also disclose their ethnic and racial status, though this is optional and used solely for statistical purposes. A section is dedicated to previous educational licenses, allowing applicants to detail any licenses held in Oregon or other states, as well as their educational history. Furthermore, the form requires a list of professional experience in education over the past five years, showcasing the applicant's qualifications. Importantly, the C-1 form includes a statement of professionalism, underscoring the ethical standards educators are expected to uphold. Character questions are also a critical component, necessitating careful responses regarding any past misconduct or legal issues. Completing this form accurately and submitting it on time is vital for those wishing to serve Oregon's K-12 students effectively.

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Preview - Oregon Tspc C 1 Form

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.______________________________ ___________________________ ___________________________ ________________________

College or University

City & State

Major/Program

Degree earned (BS, MAT, etc.)

3.______________________________ ___________________________ ___________________________ ________________________

College or University

City & State

Major/Program

Degree earned (BS, MAT, etc.)

4.______________________________ ___________________________ ___________________________ ________________________

College or University

City & State

Major/Program

Degree earned (BS, MAT, etc.)

5.______________________________ ___________________________ ___________________________ ________________________

College or University

City & State

Major/Program

Degree earned (BS, MAT, etc.)

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

City & State

Grade

Contracted

Substitute

From:

To:

 

Level(s)

½ time or more?

experience?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

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.

1.

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

1.

 

educational or school-related employment when you had reason to believe an investigation for

 

 

 

misconduct was underway or imminent?

 

 

 

 

2.

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

2.

 

agency?

 

3.

Have you ever been placed on leave by your employer for any alleged misconduct?

3.

 

 

 

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

4.

 

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?

5.

 

 

 

6.

Have you ever surrendered a professional license of any kind before its expiration?

6.

 

 

 

7.

Have you ever been disciplined by any public agency responsible for licensure of any kind,

7.

 

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

8.

 

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

9.

 

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

Key takeaways

The Oregon TSPC C-1 form is essential for educators seeking licensure or registration in Oregon. Understanding the key elements of this form is crucial for successful completion and submission.

  • Read Instructions Thoroughly: Before filling out the form, carefully review all instructions to ensure compliance with requirements.
  • Legibility is Key: Write clearly using black or blue ink. Illegible entries may delay processing.
  • Provide Accurate Information: Ensure all details, including your full legal name and contact information, are correct.
  • Social Security Number Requirement: Your SSN is necessary for child support enforcement and state tax collection. It may also be shared in certain disciplinary cases.
  • Ethnic and Race Status: While optional, providing this information aids in statistical analysis. You may select multiple categories.
  • Previous Licenses: Disclose any prior Oregon educational licenses or licenses from other states, including details about their validity.
  • Purpose of Application: Clearly indicate whether you are applying for a new license, adding endorsements, renewing, or registering with a charter school.
  • Academic Background: List all degrees and educator programs completed, regardless of their connection to licensure.
  • Professional Experience: Document your last five years of employment in education, including roles as a teacher, counselor, or administrator.
  • Character Questions: Answer all character-related questions truthfully. Any "yes" responses require detailed written explanations.
  • Signature and Date: Sign and date the application within 60 days of submission. This confirms the accuracy of the information provided.
  • Mailing Instructions: Submit the completed form directly to the TSPC at the specified address. Do not send it electronically.

Completing the Oregon TSPC C-1 form accurately and thoroughly will help facilitate the licensing process, ensuring you meet all necessary requirements for your educational career in Oregon.

File Details

Fact Name Details
Governing Laws ORS 25.785, ORS 305.385, ORS 342.143, ORS 342.175 to 190, 42 USC § 666(a)(13), 42 USC § 405(c)(2)(C)(i)
Purpose of Form This form is used to apply for an educator license or registration in Oregon.
Signature Requirement Applicants must sign the form, attesting to the accuracy of the information provided.
Social Security Number Providing your SSN is mandatory for child support enforcement and state tax collection.
Ethnic and Race Status Applicants can voluntarily disclose their ethnicity for statistical purposes.
Professional Experience Applicants must list their employment experience as an educator over the past five years.
Character Questions Applicants must answer character-related questions truthfully; any "yes" answers require explanations.

Documents used along the form

The Oregon TSPC C-1 form is essential for applying for or renewing an educator license or registration. However, several other documents are often required alongside this form to ensure a complete application. Below is a list of these additional forms and documents, each serving a specific purpose in the application process.

  • Official Transcripts: These documents verify the academic credentials of the applicant. They confirm that the applicant has completed the necessary coursework and earned the degrees claimed in the application. Submitting official transcripts is often a requirement for various types of license applications.
  • Background Check Authorization: This form grants permission for the Teacher Standards and Practices Commission to conduct a background check on the applicant. It is crucial for ensuring that all educators meet the moral and ethical standards required for licensure.
  • Proof of Teaching Experience: Applicants may need to provide documentation that details their teaching experience over the last five years. This could include letters from previous employers or other official records that outline the applicant's roles and responsibilities in educational settings.
  • Promissory Note Form: To avoid any ambiguities when formalizing financial agreements, consider using a Pennsylvania Promissory Note. This form ensures clear documentation of the debt and repayment terms, which can be found at https://promissoryform.com/blank-pennsylvania-promissory-note/.
  • Character Reference Letters: These letters serve as endorsements from colleagues or supervisors who can attest to the applicant's professional conduct and character. They provide additional context about the applicant's qualifications and suitability for a teaching position.

Gathering these documents can help streamline the application process and increase the chances of a successful outcome. It is important to ensure that all materials are accurate and submitted in accordance with the guidelines provided by the Teacher Standards and Practices Commission.