*Indicates required fields that must be completed for consideration in funding
Arizona Subsidy Application for National Board Funding
PLEASE SUBMIT CURRENT RESUME ALONG WITH APPLICATION.
*Candidate ID Number Ethnicity. Please check one. Hispanic African American Native American Caucasian Asian Other
*Prefix Mr. Ms. Mrs.
_____I would like to be considered for a State Farm Grant
Miss MI First Name
*Last Name *Home Mailing Address
City State
Zip Code
*Home Telephone *Home Email Address *School District *School Address
City State Zip Code *School Building
*School Telephone # *School Email Address *Completed a Pre-Candidacy Course:
Location:
*School FAX #
Yes
No
Instructor:
*Hold a valid Arizona Teaching Certificate: *Are you currently teaching in a classroom? *Number of years teaching? ________ *Type of school *Type of district *Certificate Area *Development Level
Public Rural Private Urban
Yes Yes
No No
Charter Suburban
I meet the requirements for National Board Certification. Baccalaureate degree State teaching license for 3 years 3 years teaching experience
Award Notification ____________ Accepted award Allocated funds _____________ _____________
Complete additional information on the back
Partial financial support (up to ½ the NBPTS fees) is available through the Candidate Subsidy Program. This program, made possible through annual appropriations from the United States Congress, provides funds to a limited number of candidates in each state to help offset the assessment fee. Subsidies will be awarded to candidates in high need areas first, and preference will be given to those who have completed a pre-candidacy course. I am applying for the federal candidate subsidy for teachers seeking voluntary certification under the National Board for Professional Teaching Standards (NBPTS). I understand that the role of the State of Arizona in the candidate subsidy program is limited to coordinating the selection of teachers to receive the subsidy and that all assessments and resulting certifications are performed under the authority and rules of NBPTS. By completion of this application, I hereby request consideration for Arizona State Subsidy Funding.
Signature Date
Required information includes:
Arizona Subsidy Application Current Resume/Vita
NOTE: Applications will not be considered without all of the REQUIRED documentation. Mail application and other information to:
Beth Driscoll, NBCT Arizona Department of Education 1535 W. Jefferson, Bin #45 Phoenix, AZ 85007 602 364-2191