Professional Teaching Standards Board - Wyoming Standard Educator License
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Professional Teaching
Standards Board
Wyoming Standard Educator License
Demonstration of Competency
Pre-Evaluation
Application Packet
This Application Packet is for educators who are interested in receiving a pre-
evaluation of their coursework before adding the endorsement
Submit your complete application packet to:
Professional Teaching Standards Board
1920 Thomes Avenue, Suite 100
Cheyenne, WY 82002Application Instructions
Demonstration of Competency Pre-Evaluation
Tips for Applicants
Before completing your application, read all instructions carefully.
In order for PTSB to better serve you by processing your application quickly and efficiently, it is critical that
submitted application packets are complete and contain all supporting documentation as outlined in the
instructions and on the forms.
PTSB does NOT accept photocopied, faxed, or scanned applications.
Application processing times vary throughout the year and depend upon whether an applicant is required to
submit fingerprints cards or not. Check our current processing time by visiting the PTSB homepage:
http://wyomingptsb.com.
It is the applicant’s responsibility to maintain current information (including Name, Mailing Address, Phone
Number, and Email Address) on file with the Professional Teaching Standards Board.
o To update your information please contact our office at 307-777-7291.
Applying for a Demonstration of Competency Pre-Evaluation is away to be guided on the process of adding an
endorsement area to your current Wyoming Standard Educator License. By completing this packet, PTSB staff
will review your proposed list of courses and provide feedback on what courses you will still need to take in
order to add an endorsement to your license via the Demonstration of Competency (DOC).
Applicants who complete the Demonstration of Competency Pre-Evaluation process and subsequently add the
endorsement within two (2) years of receipt of the Pre-Evaluation request will receive a $50 credit toward
the Add Endorsement application fee.
Application Process
Step 1 — Complete the Wyoming PTSB Application Form
Section I – APPLICANT INFORMATION (Page 6)
o Complete the information as outlined.
Section II – LICENSING AND LEGAL INFORMATION (Pages 6 and 7)
o Please make sure you carefully read and complete pages 6 and 7 of the application.
o Any disclosure must be accompanied by a personal statement indicating the circumstances and
other related legal documentation (if applicable) to be considered complete. For more information
regarding your personal statement, see page 6.
o Failure to disclose will delay your application. This may also lead to forfeiture of your fee, denial,
or cancelation of your application.
o If you have any questions regarding your particular circumstance(s), please contact our office at
307-777-7291.
o Sign and date the application (see bottom of page 7).
Section III – DEMONSTRATION OF COMPETENCY PRE-EVALUATION REQUIREMENTS (Page 8)
o Complete this section and gather any documentation required.
o Corresponding transcripts MUST be included
Section IV – DEMONSTRATION OF COMPETENCY PRE-EVALUATION WORKSHEET (Page 9)
o Fill out worksheet with relevant coursework
If additional sheets are needed please make multiple copies of the worksheet
Please refer to the DOC FAQs for tips when filling this out:
http://wyomingptsb.com/wp-content/uploads/misc/Demonstration-of-Competency-FAQs.pdf
Step 2 — Complete fingerprint cards [if applicable]
Applicants must provide fingerprints on two (2) original blue (FBI) fingerprint cards regardless of how
recently fingerprints were taken in another state or for any other purpose. Note: If you currently hold a valid
Wyoming license or permit through PTSB, you do not need to submit new fingerprint cards.
Applicants may obtain fingerprint cards and be fingerprinted by any law enforcement agency.
o If the local law enforcement agency will not provide two (2) blue (FBI) fingerprint cards, applicants may
email PTSB at wyoptsb@wyo.gov with applicant’s name and mailing address to request cards.
Include both blue fingerprint cards with your complete application packet.
BEFORE submitting your fingerprint cards, be aware of the following conditions:
o Fingerprint cards MUST be completed in black ink only.
o Fingerprint cards MUST NOT be folded, stapled, or mutilated in any way.
o Fingerprint cards MUST NOT contain any smudged or unreadable prints.
Applicants who submit fingerprint cards not adhering to the above conditions may be requested by the Wyoming
Division of Criminal Investigation to send in a second set of fingerprint cards, delaying their application.
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018Complete the following fields on BOTH of the BLUE (FBI) fingerprint cards:
Applicant completes: Signature of Person Fingerprinted and Residence of
Left Side Person Fingerprinted
Official completes: Date and Signature of Official taking the Fingerprints
Middle Applicant completes: Last Name, First Name, Middle Name (top of card),
Column Aliases (if applicable), Citizenship, Social Security Number
Applicant completes: Sex, Race, Height, Weight, Eyes, Hair, Date of Birth, Place
Right side
of Birth
Step 3 — Provide official transcripts (Page 10)
In order for PTSB to assure that courses are eligible to be applied toward a Demonstration of Competency, our
office needs official transcripts.
Request academic transcripts from ALL colleges and universities where coursework related to the
endorsement you are adding has been completed.
IMPORTANT! Be sure to have the transcripts sent directly to you (unless you are having your school send
them electronically). Once you have received all of your transcripts, include them in your completed
application packet.
Note: It is not necessary to submit official transcripts in a separate, sealed envelope; however,
transcripts must contain the institution’s original seal and registrar’s signature in order to be
considered “official”.
Step 4 – Demonstrate U.S. and Wyoming Constitution knowledge (Page 11) [if applicable]
If you currently hold or have ever held a license or permit through PTSB, you do not need to demonstrate
knowledge of the U.S. and Wyoming Constitutions again.
Applicants are required to demonstrate knowledge of both the U.S. and Wyoming Constitutions either through
an exam or college course(s). Course(s) must be passed with a grade of a “C” or better.
If you have not completed a college course(s) to meet the U.S. and Wyoming Constitution requirements, you
may demonstrate knowledge through an exam with a passing score. Exam(s) may be taken at a Wyoming
school district office or the PTSB office. Out-of-state applicants may have these exams proctored in their state
(see page 11 for more information).
U.S. and Wyoming Constitution Study Guides are available at: http://wyomingptsb.com/licensure/us-and-
wyoming-constitution/
Complete the Verification of Constitution Knowledge form and include exam results or an official
transcript indicating course(s) that meet these requirements with your complete application packet.
Step 5 — Provide testing requirements results
It is not necessary for an applicant to have taken the required exams prior to applying for a
Demonstration of Competency Pre-Evaluation. However, if test scores are available, include all
necessary test results in your complete application packet.
o Applicants adding endorsements through Demonstration of Competency are required to obtain
passing scores on approved exams (either Praxis II or Oral Proficiency Interview (OPI) exams). See
the PTSB website for current passing scores on adopted exams or visit:
http://www.ets.org/praxis/wy/alternate_route.
o For information on how to register, test sites, costs, accommodations, study guides or other
information about the Praxis II, please visit the ETS Praxis website at: www.ets.org/praxis.
Step 6 — Complete Fee Payment Form including all applicable fees (Page 12)
If you do not currently hold a valid license or permit through PTSB, be sure to include the $50 fingerprint
processing fee.
The fees may be paid by personal checks, cash, money orders, cashier’s check, and credit card.
o Please make checks payable to PTSB or Professional Teaching Standards Board.
Applicants who complete the Demonstration of Competency Pre-Evaluation process and subsequently add the
endorsement within two (2) years of receipt of the Pre-Evaluation request will receive a $50 credit toward
the Add Endorsement application fee.
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018Step 7 – Submit your complete application packet to PTSB
Your complete application packet should be submitted with the documents listed in the checklist below:
WYOMING PTSB APPLICATION CHECKLIST
(Check the appropriate box next to EACH item included)
I have included two (2) original blue (FBI) fingerprint cards [if
applicable] (see pages 2 and 3)
I have completed Sections I and II – Legal and Licensing
Information (see pages 6 and 7)
I have included a personal statement and court documents [if
applicable] (see pages 6 and 7)
I have completed Section III and IV– DOC Pre-Evaluation
Worksheet(see pages 8 and 9)
I have included official transcripts from all institutions I have
attended (see page 10) (photocopied, faxed, or scanned
transcripts are not accepted)
I have included the Verification of Constitution Knowledge form [if
applicable](see page 11)
I have included my results from the PTSB approved test (Praxis II
or OPI) [if applicable]
I have included credit card information, money order, or a check
payable to PTSB or the Professional Teaching Standards Board (see
page 12)
Submit your complete application packet to:
Professional Teaching Standards Board
1920 Thomes Ave, Suite 100
Cheyenne, WY 82002
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018Step 8 — Monitor application status
You may check the status of your application at any time by logging in to the PTSB website at
http://wyomingptsb.com.
How to check your status:
Step 1: Log in to your account. If you do not already have an account, you will need to click “Register
for an Account” and create an account.
Step 2: Select “Educator Section: Click Here”
Step 3: Select “View Report of your Licensing Information”
Step 4: Underneath the applicant information section you will see the following:
Estimated application processing times:
Fingerprints During the School Year During the Summer Months
NOT REQUIRED Two-to-four weeks Four-to-six weeks
REQUIRED Six-to-eight weeks Eight-to-twelve weeks
These processing times are just estimates; they can be shorter or longer depending on each
individual situation.
Help Us Avoid Processing Delays
Our goal is to process your application and review your DOC Pre-Evaluation in a timely manner. To do that, we ask
that you submit your application packet with complete and accurate information. If an application is received
incomplete, you will receive a 30 Day Notice notifying you of your missing requirements. If the missing items are not
received within the 30 Days, your application may be canceled and your fee may be forfeited.
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018Wyoming PTSB Application Form
This form is required for EVERY application.
You must submit this form with your complete application packet or your application will not be processed.
Social Security No. (Required)
I. APPLICANT INFORMATION (INK ONLY) - -
Legal Last Name (Required) Legal First Name (Required) MI Maiden / Other Name
Address Date of Birth
Mailing Address:
/ /
City: State: Zip Code: Gender (Optional)
Male Female
E-Mail Address: Phone:
Primary: ( ) Work: ( )
American Indian or Alaska Native Black, African American, not of Hispanic origin
Ethnicity
Anglo, Caucasian, White, not of Hispanic origin Hispanic, Chicano, Cuban, Puerto Rican, Latino, Mexican American
(Optional)
Asian, Japanese, Chinese, Vietnamese, Korean, Filipino Native Hawaiian or other Pacific Islander
Please verify the following information:
Yes No Are you legally eligible to work in the United States?
Yes No Are you now, or have you ever been, a member of the United States military?
Are you currently employed as an educator in Wyoming? (Teacher, Substitute, Administrator, Related Services, or Coach)
District and School: ____________________________________________________________________________________
Yes No
Subject(s) and Grade Level(s) (if applicable): __________________________________________________________________
II. LICENSING AND LEGAL INFORMATION
IMPORTANT: Failure to answer any of the licensing and legal questions in a truthful and complete manner or failure to provide
truthful information or supporting documents could lead to your application being cancelled and fee forfeited. Failure to answer
could also lead to disciplinary action toward any PTSB license or permit you possess.
All conduct must be disclosed. Even if: What to include in your personal statement:
It happened more than 10 years ago Detailed explanation of each question marked “yes” on
It happened in another state, federal court, tribal, military, page 7
or jurisdiction outside the United States Dates and locations
You did not go to court and your attorney went for you Final disposition and/or what was done to resolve the
You did not go to jail or the sentence was only a fine or situation
probation Documentation regarding:
You received a certificate of rehabilitation o Disposition of arrest and/or conviction
Note: If your conviction was later dismissed, expunged, o Any investigation or discipline on a professional
set aside, or the sentence was suspended, you may be license
required to provide court documentation verifying the final
disposition.
Below are examples of personal statements:
Acceptable:
“I was arrested for shoplifting in May of 1983. I was sentenced to pay restitution and received a fine of $300. I paid the restitution and
fine and my case was closed. I contacted the court and was told my records are no longer available because the arrest happened over
30 years ago. The court provided me with the attached document which verifies that my records are no longer available.”
Applicant Signature
Unacceptable:
“I was convicted of a DUI in April 2003. Everything has been taken care of, and my case has been closed.”
Applicant Signature
For more information, see the Licensing and Legal FAQs at http://wyomingptsb.com/frequently-asked-questions/faq-legal/
Legal Questions Found on Page 7
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018II. LICENSING AND LEGAL QUESTIONS [Required]
WARNING: Answers to the following questions are required. For each question that applies to you, you must
answer “yes”, EVEN IF you have already answered “yes” in a previous application. Answering “yes” does not
lead to the automatic denial of your application. If you answer “yes” to any question, you must submit a signed
Legal Last Name (Required) Legal First Name (Required) MI
personal statement and supporting documents (if applicable) even if you have previously submitted a statement.
For more information on personal statements, see page 6
Yes No Have you ever had any license, permit, or certificate from ANY professional licensing authority (education,
1 nursing, speech-language pathology, etc.) suspended, revoked, voided, canceled, denied, rescinded,
rejected, and/or otherwise taken away in Wyoming, any other state, or elsewhere?
Yes No Is there any action or investigation pending against a license, permit, or certificate held by you from ANY
2 professional licensing authority in Wyoming, any other state, or elsewhere?
Have you ever resigned, been disciplined, discharged, or asked to resign or retire from a professional position
Yes No or military service because of allegations of misconduct, or is any such action pending?
3
IMPORTANT: This includes discipline for failure or refusal to fulfill an employment contract.
Have you ever been investigated, arrested, taken into custody, cited, charged, indicted, tried, pleaded guilty to,
or convicted of a felony or misdemeanor, or been found to have committed a probation or parole violation?
Exclude minor traffic violations such as infractions, parking tickets, and speeding tickets.
Yes No
4 IMPORTANT: In responding to this question, include any pending investigation or charge. Include all cases
from federal, state, local, tribal, and military tribunals. You must also include all cases that were settled or
closed by a withheld judgement or through retained jurisdiction, etc., or handled through juvenile proceedings.
Even if you pleaded nolo contendere (no contest) you must disclose this. DUI’s or careless driving tickets
stemming from a DUI are NOT considered minor traffic violations and must be reported.
Is there any information not disclosed by your answers concerning your background, history, experience,
Yes No education, or activities which may have some bearing on your character, moral fitness or ability to hold a
5 license, permit, or certificate in Wyoming and which should be placed at the disposal or brought to the attention
of the Wyoming Professional Teaching Standards Board?
BEFORE SIGNING, CHECK PAGES 6 AND 7 FOR COMPLETENESS:
Personal information with correct SSN, Mailing Address, Phone Number, E-Mail Address, and Date of Birth filled in on page 6
All legal questions marked “yes” or “no” on page 7
Signed, detailed personal statement attached (if applicable)
Court documents (if applicable)
I attest and affirm that all statements made by me on this application are true and correct to the best of my knowledge.
I understand that penalties, which may include revocation, suspension, denial, or refusal to renew, will be imposed under WS § 21-2-
802 and PTSB Rules & Regulations, for making any false statement(s) on this application or required documents.
Applicant Printed Name _______________________________________________
III. INDIVIDUAL LICENSURE REQUIREMENTS [Required]
Applicant Signature _______________________________________________ Date ______________________
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018III. DEMONSTRATION OF COMPETENCY PRE-EVALUATION REQUIREMENTS [Required]
This section is Wyoming’s alternative route for adding an endorsement in a content area
I would like to have my courses evaluated through the Demonstration of Competency Pre-Evaluation.
A Demonstration of Competency (DOC) is Wyoming’s alternative route for adding an endorsement in the desired content area. Endorsements added
via DOC have the same validity dates as the license to which they are added. To qualify under this route, an applicant may be eligible to utilize previously
completed college coursework in the specific endorsement area for which the applicant is applying, in conjunction with passing a PTSB-approved exam.
The Demonstration of Competency can only be used to add an endorsement at the grade level for which the applicant holds a valid and current license. The
following endorsements cannot be added via DOC:
Elementary Education
School Administrator (District Superintendent, School Principal, Program Director/Coordinator)
Related Services (School Psychologist, Schhol Counselor, School Social Worker, School Nurse, and Speech-Language Pathologist)
Categorical Special Education fields (see requirements for Exceptional Generalist above)
Pre-Evaluation Requirements:
Complete the required worksheet on page 9 showing 27 semester hours of completed coursework you would like to be evaluated
Official transcripts showing the courses listed on the Pre-Evaluation worksheet
The following requirements must be met to add an endorsement via DOC:
27 semester hours of college coursework from a regionally accredited institution of higher education, in the specific content area for which the
applicant is seeking an added endorsement (multiply quarter hours by 2/3 to convert to semester hours).
Nine (9) of the 27 semester hours must have been completed within the past five (5) years.
A maximum of three (3) semester hours may be in pedagogy and must be at the grade level of the endorsement sought.
Only coursework with a grade of “C” or better, including a maximum of six (6) credits of “pass” grades equivalent to a “C” or better, will be
accepted.
Receive a passing score on a PTSB approved Praxis II exam (or OPI exam for foreign language applicants) for the requested endorsement
area.
The following requirements must be met to add a Special Education - Generalist endorsement via DOC:
Nine (9) of the 27 semester hours must have been completed with the past five (5) years.
A maximum of three (3) semester hours may be in pedagogy and must be at the grade level of the endorsement sought.
Only coursework with a grade of “C” or better, including a maximum of six (6) credits of “pass” grades equivalent to a “C” or better, will be
accepted.
Receive a passing score on a PTSB approved Praxis II exam (or OPI exam for foreign language applicants) for the requested endorsement
area.
The required 27 semester credit hours must demonstrate competency in cross-categorical standards, and include course work in:
1. Assessment
2. Instructional Strategies for Students with Disabilities
3. Behavior and Classroom Management
4. Special Education Law
Practicum - The applicant must have completed a practicum supervised by an institution of higher education, which includes a minimum of two
(2) semester hours at each grade endorsement level, and was completed within five (5) years prior to the date of application
OR
Experience – The applicant may substitute work experience for the practicum requirement. The applicant must have completed one (1) year of
successful teaching experience:
o In a cross-categorical special education setting
o At the grade level(s) for which the endorsement is being sought, as verified by a supervisor’s formal evaluation
o Within the five years prior to the date of application
Helpful Tips
Foundation or elective courses will not be accepted If you are applying for an endorsement in Social Studies Comprehension,
(i.e., ENGL 1010 or 1020 for English, MATH 1000 or courses in the following area(s) is required:
1400 for Math 6-12) o United States History
Coursework taken through the University of Wyoming o World History
College of Education or Division of Kinesiology & o Geography
Health numbered 4740 or 5959 will not be accepted o Economics
Review the Praxis “Test At-a-Glance” Test Preparation o Political Science
Materials for guidelines regarding content in each
endorsement area at www.ets.org/praxis
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018IV. DEMONSTRATION OF COMPETENCY PRE-EVALUATION WORKSHEET
Please fill out the worksheet below with coursework you would like to have evaluated in order to get customized feedback about which courses will count, and specific guidance on
remaining requirements before adding this endorsement.
For more tips, visit the Demonstration of Competency FAQs at http://wyomingptsb.com/wp-content/uploads/misc/Demonstration-of-Competency-FAQs.pdf
Demonstration of Competency Pre-Evaluation Worksheet
(If additional lines are needed to add coursework you may print multiple copies of this worksheet)
Applicant’s Name (Required) PTSB ID or SSN# (Required)
Endorsement Area Seeking: Grade Level Seeking:
Course Prefix & # Course Title Accredited Institution Grade Credits Year/Term
EX: POLS 1000 American and Wyoming Government University of Wyoming A 2012/Fall
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018VERIFICATION OF REQUESTED OFFICIAL TRANSCRIPTS
For more information on submitting transcripts please visit:
http://wyomingptsb.com/licensure/becoming-licensed/official-transcripts/
Transcripts are required from ALL institutions attended.
Applicant’s Legal Name (Required) Social Security No. (Required)
- -
Mailing Address
Street: City: State: Zip:
Telephone No. E-Mail Address
Primary: ( ) Work: ( )
ATTENTION: If you were enrolled under a different name (first or last) while attending any of the colleges or
universities listed below, make sure to indicate it below or the application process will be delayed.
Official Electronic Transcripts:
o Electronic transcripts must be sent directly from the college/university. Please have electronic transcripts
emailed to ptsbtranscripts@wyo.gov.
Official Hard Copy Paper Transcripts:
o Official hard copy paper transcripts must be included with your paper application. Please DO NOT request
the transcripts to be sent to PTSB separate from your complete application.
NOTE: If you submit official hard copy transcripts separate from your application packet or transcripts from ALL institutions attended
are not received, your application will be considered incomplete, delaying the application process.
Hard Copy Electronic Maiden/Other Names While
Date Requested College/University Name
Included Requested Attending
EX: 01/01/2017 University of Wyoming Mickey Mouse
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018VERIFICATION OF CONSTITUTION KNOWLEDGE
http://wyomingptsb.com/licensure/us-and-wyoming-constitution/
Wyoming State Statute requires applicants to demonstrate knowledge of BOTH the U.S. and Wyoming Constitutions by college
coursework or exam. Applicants who are reinstating a Wyoming license or permit have already met this requirement.
Applicant Information
Applicant’s Legal Name (Required) Social Security No. (Required)
- -
Mailing Address
Street: City: State: Zip:
Demonstration of Knowledge through College Coursework
Applicants demonstrating knowledge through college coursework must have a passing score of a “C” or better.
o Coursework for the U.S. Constitution requirement must cover U.S. history prior to 1865 and include the study of the U.S.
Constitution. Political Science courses may be counted if they covered the Constitution.
o Coursework for the Wyoming Constitution requirement must cover Wyoming history and the Wyoming Constitution.
Please list the college coursework you have taken to meet these requirements below:
Course Prefix Institution where Credit Year Course
& Number Course Title was Earned Final Grade Completed
U.S.
WY
Demonstration of Knowledge through Exam
Applicants demonstrating knowledge through an exam must receive a passing score of 75% or better.
Exams may be taken at a Wyoming school district office or the Professional Teaching Standards Board office. Study guides for
both exams are available online at http://wyomingptsb.com/licensure/us-and-wyoming-constitution/
When taking either exam, the applicant must have the exam proctor complete the ”Proctor Information” section below.
Applicants Living Outside Of Wyoming
Applicants living outside of Wyoming may request to have the exam(s) proctored by a school administrator or college faculty
member in the applicant’s state. Please email PTSB at wyoptsb@wyo.gov to request exams be sent directly to the proctor. Be
sure to include which exam(s) are needed, the full name, and email address of the proctor in your request.
Once the exams are completed, have the out-of-state proctor return the completed form and completed exams directly to you in a
signed, sealed envelope so that you may submit the envelope as part of your complete application.
This section to be completed by the exam Proctor
Wyoming proctors: Please add the exam scores where indicated and do not return the completed exam(s) to the applicant.
Out-of-state proctors: Once the exam(s) are completed, return this form along with the completed exam(s) in a signed, sealed
envelope directly to the applicant so these items may be submitted as part of a complete application packet.
Proctor Information
Printed Name Title
Company Name or School District (Include District No.) Telephone No.
Primary: Work:
Mailing Address
Street: City: State: Zip:
By signing below, I verify that the above applicant took the appropriate exam(s) as required.
Signature Date
This section for Wyoming Proctors only:
Exam Scores Received: U.S. Constitution ____________ Wyoming Constitution ____________
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018DEMONSTRATION OF COMPETENCY FEE PAYMENT FORM
Make fees payable to PTSB or Professional Teaching Standards Board
Fees are payable by personal check, cash, money order, cashier’s check, or credit card. Checks must be written in black or
dark blue ink only. Please be sure the applicant’s full name is written on the check.
Note: The DOC Pre-Evaluation application fee is $100. An educator who completes the DOC Pre-Evaluation process and
subsequently adds the endorsement via DOC within two (2) years of receipt of the Pre-Evaluation request will receive a $50
credit toward the Add Endorsement DOC application fee.
Fees
Demonstration of Competency Pre-Evaluation $100
Fingerprint Processing Fee $50
Demonstration of Competency Pre-Evaluation Application Fee: $______________
Fingerprint Processing Fee: (only if you DO NOT have a current PTSB permit or license) $______________
Total Amount of Fees: $______________
ONE PAYMENT MAY BE SUBMITTED TO COVER ALL APPLICABLE FEES
Make fees payable to PTSB or Professional Teaching Standards Board and staple check (written in black or dark blue ink) or money order
here or complete credit card information below:
(VISA, DISCOVER, & MASTERCARD are accepted)
Applicant’s Legal Name (Required) Social Security No. (Required)
- -
I AM MAKING PAYMENT BY CHECK, CASH, MONEY ORDER, OR CASHIER’S CHECK.
I AM MAKING PAYMENT BY CREDIT CARD. Visa MasterCard Discover
Cardholder Name (please print): Credit Card Number:
__________________________________ - - -
Expiration Date: CVC Code: (found on signature line, 3 to 4 digits)
Cardholder Contact Number:
__________________________________
-
Cardholder Billing Address:
__________________________________ _____________________________________________
Street/PO Box Cardholder Signature Date
____________________________________
City State Zip
THIS PAGE WILL BE SHREDDED AFTER PAYMENT HAS BEEN PROCESSED.
NOTE: If you submit an incorrect fee, this will delay the processing of your application. Please contact our office if you have
questions at 307-777-7291.
**All Fees Are Processed Immediately and Are Non-Refundable**
Professional Teaching Standards Board
1920 Thomes Ave. Suite 100, Cheyenne, WY 82002
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FORM_PURPLE_DOC PRE-EVAL Updated 05/01/2018You can also read
