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Home >> Teachers, Administrators and Certifications >> Applications & Forms >> Statement of Name Verification

Statement of Name Verification

The PDE Name Verification form is used to confirm an individual's current name when the Department has noted a discrepancy between the name listed on an application form submitted to the Department and the name listed in the educator's official records on file.

Name changes/verifications must be submitted through the Teacher Information Management System (TIMS)

Statement of Name Verification Form (PDF)

For additional information, please contact:

Barb Seifert | Chief, Division of Certification Services
Pennsylvania Department of Education - School Leadership and Teacher Quality
333 Market Street | Harrisburg, PA 17126-0333
Phone: 717.787.3356

Questions/Technical Difficulties? Please submit a Help Desk Ticket.