Level II Fieldwork Educator Certificate Info Form Information for Level II FW Educator Certificates Your certificate WILL PRINT EXACTLY AS YOU TYPE THE INFO HERE, so please double check your capitalization, spacing, spelling, and address for the correct info. Also, your certificate will be mailed to the address you provide here, so if you enter your work address, please include a dept name or ATTN: (your name) line, if needed. Name* First Last Credentials*Example: MS, OTR/LWhat rotation did you have students?* Level II / Rotation 1 - January 4–March 26, 2021 Level II / Rotation 2 - March 29–June 18, 2021 Both rotations Please indicate the student(s) you supervised, if possible. (This response will not appear on your certificate).*Your email address:* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
