Principal License
Verification of Experience Form for State of Ohio
To the Applicant: Please have this form signed by the School District to verify dates, the
number of years of teaching experience and grade levels.
Please indicate below to which age/grade levels you are applying:
Principal (ages 3-12 and grades PK-6)
Principal (ages 8-14 and grades 4-9)
Principal (ages 10-21 and grades 5-12)
To the School District: Please sign to verify dates and grade levels of the applicant: The
applicant has completed a minimum of two years of successful teaching under a provisional,
resident educator or professional teacher license (or certificate) at the age/grade levels for
which the principal license above is sought;
Dates: From:_________________ To: ________________ Grade Level: _________________
Dates: From:_________________ To: ________________ Grade Level: _________________
Dates: From:_________________ To: ________________ Grade Level: _________________
RE:
Applicant’s First Name
Last Name
Middle Name
Address
Street
State ID# or Social Security#
City
State
Telephone#(
)
Zip Code
___________
This is to verify that:
(Applicant’s name as listed above)
is applying for the State of Ohio, Principal license and has met the experience outlined above
for this license. The applicant has completed a minimum of two years of successful teaching
under a provisional, resident educator or professional teacher license (or certificate) at the age
levels for which the principal license above is sought;
School District’s (Signature)
Date
Name of person completing the form (please print or type)
School District’s Name & Address (print or type)
Telephone#(
)
E-Mail _____________________________
Please email completed form to: XUlicense@xavier.edu
or mail to: Ms. Renée Gosney
Xavier University/School of Education
3800 Victory Parkway, Cincinnati, Ohio 45207-3224