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Step 1 of 7: Enter Personal Information
Your Social Security Number (required):  -  - 
 
Gender: Title:
Date of Birth (required): First Name (required):
     Middle Name:
Last Name (required):
Suffix:
 
Step 2 of 7: Disclosure
Have you ever had an educator credential revoked, suspended, limited, investigated or surrendered?
If Yes, in what state?
 
 
Have you ever been convicted of a criminal offense (excluding moving violations)? If Yes, please provide a brief explanation in the space provided.
 
In the event that you are not employed in the State of Delaware as an educator, would you like to be contacted by Delaware school district personnel offices about potential employment opportunities?
 
Step 3 of 7: Attestment
 The information I am about to submit to the Department of Education is truthful and accurate to the best of my knowledge at the time of submission.
 
 
 
  
 
 
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