National Board Bonus Information Form Instructions: Please complete the form below for EACH school that you have a teaching assignment with and return it to your Human Resources office. If you have any questions please direct them to those within your HR office. First Name: Last Name: School Name: WA State Certification #: (Expiration date is 10 years from the date National Board Certification Expiration Date (eg 11/20/2019): of NBCT score release) Is this your first year in this school? Percent of Assignment at this Building: Please select your National Board Certificate area: Early Childhood/Generalist (ages 3–8) Early and Middle Childhood/Art (ages 3–12) Early and Middle Childhood/English as a New Language Early and Middle Childhood/Physical Education (ages 3–12) This certificate also includes Bilingual (ages 3–12) (Spanish/English). Early and Middle Childhood/Music (ages 3–12) Early Childhood through Young Adulthood/ Exceptional Needs Specialist (birth–21) Early and Middle Childhood/Literacy-Reading Language Early Childhood through Young Adulthood/ School Arts (ages 3–12) Counseling (birth–21) Early Childhood through Young Adulthood/ Library Media Early Adolescence/English Language Arts (ages 11– (ages 3–18+) 15) Middle Childhood/Generalist (ages 7–12) Early Adolescence/Science (ages 11–15) Early Adolescence/Mathematics (ages 11–15) Early Adolescence through Young Adulthood/Art (ages 11–18+) Early Adolescence/Social Studies-History (ages 11–15) Early Adolescence through Young Adulthood/ English as a New Language (ages 11–18+) Early Adolescence through Young Adulthood/ Career and Early Adolescence through Young Adulthood/ Music (ages 11–18+) This certificate also includes Bilingual Technical Education (ages 11–18+) (Spanish/English). Early Adolescence through Young Adulthood/ Physical Early Adolescence through Young Adulthood/ Education (ages 11–18+) World Languages other than English (ages 11–18+) Adolescence and Young Adulthood/Mathematics (ages 14– Adolescence and Young Adulthood/English 18+) Language Arts (ages 14–18+) Adolescence and Young Adulthood/Social Studies-History Adolescence and Young Adulthood/Science (ages (ages 14–18+) 14–18+) Early Adolescence/Generalist (ages 11-15) Early Adolescence through Young Adulthood /Health (ages 11–18+) FOR HUMAN RESOURCE STAFF ONLY Please check all applicable duty roots: 21x Elementary Principal 43 Occupational Therapist 22x Elementary Vice Principal 44 Social Worker 23x Secondary Principal 45 Speech-Language Pathologist or Audiologist 24x Secondary Vice Principal 46 Psychologist 31 Elementary Teacher 47 Nurse 32 Secondary Teacher 48 Physical Therapist 33 Other Teacher 49 Reading Resource Specialist If the district certifies that the employee is 52 Long Term Substitute Teacher 40 assigned teaching responsibilities or serves as a mentor teacher 41 Library Media Specialist 63 Contractor Teacher 42 Counselor 64 Contractor Educational Staff Associate *Please note that principals are only eligible for the NBPTS Teacher Bonus if they first received the bonus as a teacher. Please refer tohttp://www.k12.wa.us/Certification/NBPTS/TeacherBonus.aspx for details regarding the NBPTS teacher bonus and eligibility guidelines.
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