Questionnaire/Registration for 2019-2020 SEA National Board Candidate Support Program
Welcome! Completed registration forms and deposits received by SEA will have a confirmed spot in the 2019-20 National Board support cohort. If you have any NB Support Cohort questions, please email Lead NBCT Coordinator Mary Lanza at mjlanza@seattleschools.org.

>>To submit your payment, please print and send a copy of this printed form (https://tinyurl.com/SEANBRegistration18-19) (Never mind what year the link says - the form is still good.) and non- refundable $75 Registration Fee* (check, not cash please) to:

Seattle Education Association
Attn: National Board Registration
5501 4th Ave South
Suite #101
Seattle, WA 98108

*Registration fee is required to secure your place in a cohort. You may include support fees at this time or bring the support fees to your first meeting.

* Required

First Name *
Your answer
Last Name *
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Home Email
Your answer
School Email *
Your answer
At which school/building do you work? *
Your answer
What grade level(s) do you teach?
Your answer
What is your Certification Expiration date? *
MM
/
DD
/
YYYY
What is your anticipated certification area? (Find more information about Certification Areas at: http://boardcertifiedteachers.org/certificate-areas) *
Are you a WEA JumpStart attendee? *
National Board Foundations Course (Optional- Recommended for all, Required for OSPI Loan Recipients. This requirement is fulfilled if you attended WEA JumpStart)
Select the Components you plan to pursue this year (Please note support fees): *
Required
Submit
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