2014-2015 Application for NYS Albert Shanker Grant Program


Instructions:

Before submitting this application for the Albert Shanker Grant Program you must :

This Albert Shanker Grant Program application must be submitted by December 31, 2014.
As part of this application you must send to the Office of Teaching Initiatives verification that you have registered and paid for the first exam component with NBPTS. Please mail or fax verification to:

NYS Education Department, Office of Teaching Initiatives
Attn: Albert Shanker Grant Program
89 Washington Avenue, Room 5N-EB
Albany, NY 12234
FAX #: (518) 473-0271, Attn: Albert Shanker Grant Program


* Denotes a required field


Candidate Information
* First Name:
* Last Name:
* Maiden Name:
Please provide your maiden name or type Not Applicable in the text box.
*Last 4 Digits of SSN
Please provide the last 4 digits of your SSN.
*Date of Birth
(MM/DD/YYYY format)

Phone Number:
* Home:
() -
* Cell:
() -

* Email Address:
* National Board Candidate ID Number:

Home Address
* Street 1:
Street 2:
* City:
* State:
* Zip Code:

Employing NYS Public School District Information

* Name of NYS Public School District:
* Superintendent Name:
* School Building:
* School Address - Street 1:
School Address - Street 2:
* City:
* State:
* Zip Code:
* School County:
* School Phone Number:
() -
* School Email Address:

NYS Teacher Certification Information – List type, title, and grade level for all certificates held

Please Note: Enter this information all on one line. Do not press the enter button to create multiple lines.
* Certificate 1:
  Certificate 2:
  Certificate 3:
  Certificate 4:
  Certificate 5:

Online Affidavit

Read all statements, check all boxes and then click on the “Sign Affidavit” button:
* I have paid the required annual registration fee and registered and paid for the first component to the NBPTS.
* If I withdraw my candidacy, I understand that I am responsible for repayment of any grant funds not recovered due to my early withdrawal.
* I do not have additional third-party support applicable toward the NBPTS component fees.
* I agree to remain employed full-time in a NYS public school district for at least one year after completing or achieving National Board Certification.
* I am employed and TENURED as a full-time teacher in a New York PreK-12 Public School.
By SIGNING this affidavit, I hereby certify that all of the information I provided in this online application is true and contains no misrepresentation or falsehoods and is signed under penalty of perjury.

By clicking the “Sign Affidavit” button you are submitting the NYS Albert Shanker Grant application.

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Last Updated: September 12, 2014