Waiver Request

I. INFORMATION FOR THE UNIVERSITY

University where course(s) will be taken
(including OSU Marion):

OSU ID#
(if applicable): Term: Year:

College or division to be attended
(for grad school, indicate grad only): Credit Hours:

APPLICANT INFORMATION

Last 4 SSN: Last Name:

First Name: Middle Initial:

Email Address:

II. INFORMATION FOR THE DIOCESAN SCHOOL OFFICE

SCHOOL INFORMATION

Name:

Address:

City: State: Zip:

Number of years you have taught in Diocese of Columbus
(do not include current school year):

FULL-TIME / PART-TIME?

Full-time

Part-time

What grade level?

Were you a cooperating teacher the previous school year?

Yes

If so, which college or university?

When?

From: Year:

To: Year:

Working with student teachers?

Or early experience?

Or other (specify):

Only third or fourth level undergrad course work and all graduate course work may be used when upgrading certificate from a provisional to a professional.

The Columbus Catholic Schools have exchange of service agreements with the following colleges/universities:
ODU, OSU, Ashland University, Mt. Vernon Nazarene University, and Otterbein College.