National Board Bonus Information Form by nrk14057


									                                          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)
 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+)
  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 to for details regarding the NBPTS teacher bonus and eligibility guidelines.

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