AZ NBCT Network Application

Welcome to the Arizona NBCT Network!

The Arizona NBCT Network is a part of the work at the Arizona K12 Center. Our vision is that every child in Arizona is taught by an accomplished teacher. Our mission is to empower Arizona's National Board Certified Teachers as leaders and advocates for the profession.

To achieve this vision and our mission, the Arizona NBCT Network will provide opportunities for Arizona’s NBCTs to exchange ideas, learn, and challenge themselves and each other to improve education in the state of Arizona by:

Engaging stakeholders to create awareness around National Board Certification and its impact on students, school systems, and the career continuum
Connecting NBCTs throughout Arizona
Developing and supporting accomplished teachers as leaders and advocates
Celebrating and honoring Arizona’s NBCTs

We are asking you to complete this Network application. This will help us guide our work and advance accomplished teaching in Arizona.

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* 1. Are you a new NBCT or Renewed NBCT?

New

Experienced/Continuing

Renewed:
Provide date of original certification(s):

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* 2. What is your certificate area?

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* 3. First Name

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* 4. Last Name

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* 5. Current Position/Job Title

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* 6. Cell Phone (please include area code)

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* 7. Personal Email Address

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* 8. Work Email Address

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* 9. Home Mailing -- Street Address

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* 10. Home Mailing -- City

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* 11. Home Mailing -- State

Other (please specify)

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* 12. Home Mailing -- Zip Code

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* 13. Principal/Supervisor's Title

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* 14. Principal/Supervisor's First Name

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* 15. Principal's/Supervisor's Last Name

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* 16. Name of School or Workplace

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* 17. School/Workplace -- Address

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* 18. School/Workplace -- City

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* 19. School/Workplace -- State

Other (please specify)

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* 20. School/Workplace -- Zip Code

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* 21. School/Workplace-- County

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* 22. Work -- Phone (please include area code)

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* 23. Superintendent's Title

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* 24. Superintendent's First Name

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* 25. Superintendent's Last Name

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* 26. Name of District or Charter

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* 27. District/Charter -- Street Address

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* 28. District/Charter -- State

Other (please specify)

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* 29. District/Charter -- Zip Code

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* 30. Where did you get your degree(s)?

BA/BS:

MA:

EDD/PHD:

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* 31. What endorsements, if any, do you hold?

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* 32. We believe all teachers develop areas of expertise over time. These are often rooted in their passions and/or experiences. What do you think are your areas of expertise?

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* 33. We often receive requests for the names of NBCTs to serve in a myriad of roles. Please mark any of the roles/areas you might be interested in.

Teach a class at the community college/university level.

Have a student teacher or intern in my classroom.

Lead an after school professional development.

Write a blog and/or op ed piece for a newspaper.

Serve on a state standards committee.

Be a guest speaker.

Other (please specify)

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* 34. Are you still teaching in a classroom?

Yes

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* 35. If you answered "yes" to the question above (#34), what is your current assignment?

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* 36. Are you currently serving in a mentoring or coaching role?

Yes

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* 1. Are you a new NBCT or Renewed NBCT?

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* 2. What is your certificate area?

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* 3. First Name

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* 4. Last Name

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* 5. Current Position/Job Title

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* 6. Cell Phone (please include area code)

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* 7. Personal Email Address

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* 8. Work Email Address

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* 9. Home Mailing -- Street Address

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* 10. Home Mailing -- City

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* 11. Home Mailing -- State

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* 12. Home Mailing -- Zip Code

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* 13. Principal/Supervisor's Title

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* 14. Principal/Supervisor's First Name

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* 15. Principal's/Supervisor's Last Name

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* 16. Name of School or Workplace

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* 17. School/Workplace -- Address

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* 18. School/Workplace -- City

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* 19. School/Workplace -- State

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* 20. School/Workplace -- Zip Code

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* 21. School/Workplace-- County

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* 22. Work -- Phone (please include area code)

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* 23. Superintendent's Title

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* 24. Superintendent's First Name

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* 25. Superintendent's Last Name

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* 26. Name of District or Charter

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* 27. District/Charter -- Street Address

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* 28. District/Charter -- State

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* 29. District/Charter -- Zip Code

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* 30. Where did you get your degree(s)?

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* 31. What endorsements, if any, do you hold?

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* 32. We believe all teachers develop areas of expertise over time. These are often rooted in their passions and/or experiences. What do you think are your areas of expertise?

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* 33. We often receive requests for the names of NBCTs to serve in a myriad of roles. Please mark any of the roles/areas you might be interested in.

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* 34. Are you still teaching in a classroom?

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* 35. If you answered "yes" to the question above (#34), what is your current assignment?

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* 36. Are you currently serving in a mentoring or coaching role?

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* 37. If you answered "yes" to the question above (#36), please tell us more about your current assignment.

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* 38. Please use the space below to share anything you think pertinent and not covered in this application.