2015-2016 Application for NYS Albert Shanker Grant Program


Instructions:

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

  • Read the information regarding National Board Certification at:http://www.nbpts.org/policies-and-resources.
  • Complete the 2015-2016 National Board for Professional Teaching Standards (NBPTS) Candidate Registration online at:https://nbcmsprod.perfrms.com/
    (Note: During the NBPTS registration process, under the "Agreements" tab [Step 4], you must elect to have your name released to third-party agencies that may provide incentives).
  • Pay the annual NBPTS registration fee and register and pay for your first component.

This Albert Shanker Grant Program application must be submitted by January 31, 2016.

As part of this application you must send to the Office of Teaching Initiatives verification that you have registered and paid for your first component with NBPTS. Please email verification to: shankergrant@nysed.gov.


* 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 NBPTS the annual registration fee and the fee for my first component.
* 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: August 3, 2015