WASHINGTON STATE 4099-2026

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The document outlines the certification requirements for Initial Educational Staff Associates (ESAs) in Washington State, specifically for roles such as School Nurse, Occupational Therapist, Physical Therapist, Social Worker, and Speech Language Pathologist or Audiologist. It details the necessary educational qualifications, licensing requirements, application instructions, and background check procedures. Additionally, it provides information on required courses and examinations for certification, along with a checklist for applicants to ensure all necessary documentation is submitted.

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Click ‘Get Form’ to open the WASHINGTON STATE 4099 in the editor.
Begin by filling out your personal information in Section 1, including your name, address, and date of birth. Ensure all details are accurate.
In Section 2, indicate the ESA role you are applying for by selecting from options such as School Nurse or School Occupational Therapist.
Complete Section 3 regarding your educational background. Attach all required official transcripts and any additional documentation requested.
If applicable, fill out the Character and Fitness Supplement (Form SPI/CERT 4020B) to disclose any relevant history that may affect your certification.
Review your application thoroughly for completeness before submitting it along with the necessary fees to the OSPI Office.

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