Rev. 4/2024
Ne
w Teacher Registration Instructions
Pl
ease complete the following form and submit with a non-refundable $75 registration fee.
Teachers must hold any Oregon licenses, certificates, and ratings, and successfully pass qualifying
exams legally required for employment in the field in which they teach [OAR 715-045-0012 (3)].
This form must be on file with the Higher Education Coordinating Commission, Office of Private
Postsecondary Education, prior to the commencement of any instruction, except when emergency
provisions are being utilized [OAR 715-045-0012 (2)].
Teacher Registration Information (There is a separate application for teacher renewals)
•
All teacher registrations are issued for a three-year period.
•
The Commission does not issue renewal notices to registered teachers. It is the responsibility
of you and your employing school to ensure your registration is kept current.
•
30 hours of Continuing Education is recommended for general PCS teachers and is required
for Cosmetology teachers. Check with the school(s) where you are teaching to see what
programs they may have approved or are offering for continuing education.
•
Please notify the Commission of any change in mailing address, e-mail or phone number.
•
There is a $75 renewal fee for each teacher registration.
•
Please verify you are using the current and approved version of this form. ALWAYS obtain
the most current application from the Commission’s website for PCS Forms and Procedures.
•
ALL sections must be completed, and this application signed and dated by teacher and director.
YOUR APPLICATION WILL NOT BE ACCEPTED IF THE FOLLOWING IS NOT INCLUDED:
Copies of current licenses or certificates legally required for employment in the field in which you
teach (i.e., cosmetology, massage technician, CDL, etc.).
Copy of either High School Diploma, High School Transcripts, High School Modified Diploma, GED
OR copy of postsecondary transcript/certificate/diploma.
Copy of most current employment résumé with details of duties that would impact this application.
A $75 non-refundable registration fee, paid by check or money order to the Higher Education
Coordinating Commission.
The School Director of the school you will be teaching at MUST sign your registration form
or your application review WILL BE delayed.
If you have a criminal history, the documentation listed on Page 4 must be included.
Psilocybin Only - OHA Oregon Psilocybin Services Training Program Curriculum Approval
Summary with the name of the teacher who is applying to HECC to be a registered teacher on the
list as an Instructor.
Rev. 3/2024
Page 2 of 6
Application for Teacher Registration
All boxes MUST be completed, all required documentation MUST be included, and your payment received for
your application to be accepted and reviewed. Applications missing this information will be delayed.
App
licant Information
(Required Information)
Applicant Name:
Date of Birth:
Social Security
Number:
Email Address: Phone:
Home Address:
City: State: Zip:
Education/Training History (REQUIRED)
Name and Location of
School Attended
Course of
Study
(Major)
Dates Attended
MM/DD/YY MM/DD/YY
Full Time /
Part Time?
Degree or
Certificate Earned
/ Number of
Hours,
(if applicable)
From To
Instructors must be at least 18 years of age. Submit a copy of your high school diploma, GED, OR
postsecondary degree diploma or certification with your application.
Please include a copy of all ‘official’ postsecondary school transcripts as listed above.
Rev. 4/2024
Page 3 of 6
Work Experience
Complete all sections below, starting with the most recent position: (REQUIRED)
Employer Name,
address, and
phone number, or
qualified teacher
training
Starting and
ending dates of
employment.
(REQUIRED)
Use MM/DD/YY format
Please indicate if
Full time
or Part time?
*Required: if part-time,
include number of
hours/month
Duties performed
(all applicants)
Please be specific on duties
as applies to this application
and the programs you will be
teaching.
Teacher
training
program
hours
(cosmetology
only)
Applicant must have had two years of work experience or two years of education, or any combination
of both, in the subject that they instruct.
• One year of experience is defined as 1,875 hours of work, education, or training per year (37.5
hours per week times 50 weeks). Part-time experience will be allowed if the total hours equal the
equivalent of two years of full-time experience (3,750 hours) [OAR 715-045-0012 (3)(d)(A)].
• FOR NEW TEACHERS, work experience MUST have been within the past FIVE years.
• If a credential or qualifying examination is required for employment in the field by the state in
which the school is located, the two years of experience must include at least one year of work
experience as a certified practitioner in the subject in which you instruct, following certification or
licensure.
Psilocybin Only – In lieu of meeting the work experience and education requirement required in OAR
715-045-0012, the teacher must provide a copy of the OHA Oregon Psilocybin Services Traini
ng
P
rogram Curriculum Approval Summary and be listed as an Educator or Instructor on the Summary.
C
osmetology only - Applicants may obtain their license by completing a 1,000 hour cosmetology
teacher training program offered by a licensed private career school, if the applicant possesses a valid
credential from the Oregon Health Licensing Office. Applicants that have an expired teacher license
that is no more than three years old or was previously licensed in another state whose teacher
requirements are less than those in Oregon can take a 200-hour teacher training program offered at a
licensed career school.
Rev. 3/2024
Page 4 of 6
Other Postsecondary Work
List summer schools, extension courses, seminars, military experience, etc.
Program and Courses
Please list all Programs and Courses which applicant will be offering instruction. The name of the programs
listed MUST be the same name as the programs listed on the school’s license. Courses within the program may
vary
(REQUIRED):
Program
Course
This section must be completed (use additional sheets if needed).
Criminal History
Have you ever been convicted of a crime other than a minor traffic violation? Please check the
appropriate box below [OAR 715-045-0012 (13)].
Yes No
If you answered ‘Yes’, your application MUST also include:
A letter of explanation for the criminal history and what has changed in your life.
Letter of Recommendation from your employing school, and
Letter of Recommendation from your most recent employer, parole officer or other
appropriate professional source.
Final Court Record or Disposition.
Be advised: If you work at a school that enrolls minors you WILL BE required to have a fingerprint
background check completed. Check with the school you are considering working for to verify if this
would be a requirement in OAR 715-045-0003.
Rev. 3/2024
Page 5 of 6
Licenses held pertaining to this application
Name of License Held Regulating agency
Expiration
Date
School you plan on working for:
Name of School
School Location
Signature and Authorization
I hereby certify the above information is true and correct to the best of my knowledge. I am aware that
if any statement made herein has been misrepresented, my registration as an instructor may be
suspended or revoked.
P
rint Applicant’s Name Signature of Applicant
Date
Print School Director’s Name Signature of School Director Date
Designated School Director must sign above for this application to be accepted
PLEASE NOTE: Notification of approval or denial, plus any registration certificates will be sent
directly to the School Director at the address and/or email registered with the HECC.
You must mail the $75 registration fee
with the name of the applicant listed on the check for verification.
M
ail your application and fee to:
HIGHER EDUCATION COORDINATING COMMISSION
Office of Academic Policy and Authorization
PCS Licensing Unit
3225 25th Street SE
Salem, OR 97302
Rev. 3/2024
Page 6 of 6
FOR YOUR RECORDS ONLY (do not return to HECC):
Social Security Number Requirement, Authority, and Disclosure Statement
A
s part of your application for an initial or renewed registration as a teacher, director, or agent for a
licensed private career school, as issued by the Higher Education Coordinating Commission, Office
of Private Postsecondary Education, you are required to provide your Social Security Number
(SSN) to the Commission as part of the application process [ORS 25.785 and 42 USC §
666(a)(13)].
Your SSN will be stored in the Commission’s electronic database using the highest level of encrypted
security protocols. It will be provided on a quarterly basis to the Oregon Department of Justice through
secured electronic means for the purpose of enforcing child support orders. Your SSN will not be
printed or displayed in any public forum through any medium unless expressly required by state or
federal law.
Fai
lure to provide your SSN will be a basis for the Higher Education Coordinating Commission,
Office of Private Postsecondary Education, to refuse to issue or renew a license or registration as
described above.
Any other use or disclosure of your SSN will require your written authorization.
