Southern Union Office Education
Application for
Renewal or Reinstatement of
Certification
Complete this form and mail or email to the address listed at the bottom of the form.
If you have completed any academic courses since your last renewal, please request an official transcript to be
mailed or emailed to the transcript address at the bottom of the form.
Certificate type(s) for which I am renewing/reinstating:
A. Basic
C. Professional/Administrator
E. Conditional
B. Standard
D. Designated Subjects/Service
F. Unknown
Print Legal Name:
First Middle Maiden Last
Address:
City: ST. Zip:
Phone Number: NAD Teacher ID # Check if new address
Birthdate: Email:
CERTIFICATION INFORMATION:
What denominational teaching certificate do you now hold?
Date Issued: Union Name:
If now teaching, at what school? Conference:
This application indicates that I am an active member of the Seventh-day Adventist Church and certify that it is my intention
to subscribe to and teach within the framework and philosophy of the Seventh-day Adventist Church as outlined in the General
Conference Working Policy and the employment policies of the Southern Union Conference EducationCode.
Signature: Date:
Mail form and official transcripts
to: Office of Education/
Certification Southern Union
Conference
P.O. Box 923868
Peachtree Corners, GA 30010-3868
408-770-1800
Email form to:
Bcalderon@southernunion.com
Lbiggs@southernunion.com
Email for Official Transcripts:
Certificat[email protected]
Revised 01-2024
Renewal or Reinstatement Only 1 of 1
