Request edit access
Northern Lights ATA #15 Retirement Form
Northern Lights Local #15 is pleased to recognize your years of service with a gift.  Please complete this form at the time of your retirement to be eligible.

Please note:

This application must be submitted by the last day of the school year in which you retire.
Retirement gifts will be paid by September 30th of the current year.
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
At which school did you last teach? *
Address to which the gift should be mailed *
Please include complete mailing address including postal code.
Personal Phone Number *
Date of Retirement *
MM
/
DD
/
YYYY
Eligible Service
Using your Alberta Teachers Retirement Fund Contribution and Service Record, calculate your TOTAL pensionable service years with Northern Lights School Division #69 and the following if applicable:

-Medley School District
-Bonnyville Centralized High School District
-Bonnyville School Division #46
-Lakeland Catholic School Divison (service before January 1, 1995 only)
-Lakeland Public School District #5460
-Lac La Biche School District
Total Years of Service *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms