DIVISIÓN DE

CERTIFICACIONES DOCENTES
CERTIFICACIÓN MÉDICA

La siguiente certificación médica será utilizada única y exclusivamente para la solicitud

de renovación de certificados y solicitudes nuevas, de conformidad con el Reglamento
para la Certificación del Personal Docente del Departamento de Educación de Puerto
Rico.

Certifico que ____________________________________________ con número de

identificación ___________________ y nacido en _________________, no tiene

defectos físicos, enfermedades o incapacidad alguna que le impida el llevar a cabo los

deberes como: ____ maestro ____ director ____consejero ____otro_______________.

Fecha_________________ Nombre del Dr. que certifica _______________________

Firma________________________ Número de licencia ________________________

Dirección: _____________________________________________________________

Sello

P . O . B o x 1 9 0 7 5 9 , S a n J u a n P R 0 0 9 1 9 - 0 75 9 ( 7 8 7 ) 7 73 - 6 2 8 6 / 2 4 8 3 / 2 5 7 3 / 62 8 4 / 6 60 0 / 2 4 5 7

E l D e p a r t a m e n t o d e E d u c a c i ó n n o d i s c r i m i n a d e n i n g u n a m a n e r a p o r r a z ó n d e e d a d , r a z a , c o l o r , s e xo ,
n a c i m i e n t o , c o n d i c i ó n d e ve t e r a n o , i d e o l o g í a p o l í t i c a o r e l i gi o s a , o r i g e n o c o n d i c i ó n s o c i a l , o r i e n t a c i ó n
s e xu a l o i d e n t i d a d d e g é n e r o , d i s c a p a c i d a d o i mp e d i m e n t o f í s i c o o m e n t a l ; n i p o r s e r v í c t i m a d e
vi o l e n c i a d o m é s t i c a , a gr e s i ó n s e xu a l o a c e c h o .
 DIVISION OF
TEACHING CERTIFICATIONS

MEDICAL CERTIFICATION FOR THE PUERTO RICO

DEPARTMENT OF EDUCATION

The following medical certification will be used solely and exclusively for the request for
renewal of certificates and new applications, in accordance with the Regulations for the
Certification of Teaching Personnel of the Puerto Rico Department of Education.

I certify that ____________________________________________ with identification

number ___________________ and born in ___________________________, has no

physical defects, illnesses or any disability that prevents him from carrying out the duties

as: ____ teacher ____ principal ____ counselor ____other_______________________.

Date_________________ Name of the certifying Dr. ___________________________

Signature________________________ License number ________________________

Address: ______________________________________________________________

______________________________________________________________________

P . O . B o x 1 9 0 7 5 9 , S a n J u a n P R 0 0 9 1 9 - 0 75 9 ( 7 8 7 ) 7 73 - 6 2 8 6 / 2 4 8 3 / 2 5 7 3 / 62 8 4 / 6 60 0 / 2 4 5 7

E l D e p a r t a m e n t o d e E d u c a c i ó n n o d i s c r i m i n a d e n i n g u n a m a n e r a p o r r a z ó n d e e d a d , r a z a , c o l o r , s e xo ,
n a c i m i e n t o , c o n d i c i ó n d e ve t e r a n o , i d e o l o g í a p o l í t i c a o r e l i gi o s a , o r i g e n o c o n d i c i ó n s o c i a l , o r i e n t a c i ó n
s e xu a l o i d e n t i d a d d e g é n e r o , d i s c a p a c i d a d o i mp e d i m e n t o f í s i c o o m e n t a l ; n i p o r s e r v í c t i m a d e
vi o l e n c i a d o m é s t i c a , a gr e s i ó n s e xu a l o a c e c h o .