Thank you for filling out this survey.  In addition, please complete the registration form found on the VEA website at www.vancouverea.org (under documents tab) and submit with your registration fee to the VEA Office at 2509 Broadway - Vancouver WA 98663

* 1. First Name

* 2. Last Name

* 3. Home Phone xxx-xxx-xxxx

* 4. Cell Phone xxx-xxx-xxxx

* 5. Home email

* 6. School email

* 7. What school/work site do you primarily work at?

* 8. What grade level(s)/subjects do you teach?

* 9. Have you registered with the National Boards?

* 10. What is your NBCT area?  http://boardcertifiedteachers.org/certificate-areas

* 11. Do you plan to attend WEA Jump Start?

* 12. Did you attend WEA Jump Start?

* 13. Do you plan to take the Foundations Course?  The Foundations Course is highly recommended if you did not attend Jump Start and mandatory if you did not attend Jump Start and are applying for a Conditional Loan through OSPI.

* 14. Which Components will you be pursuing this year?  (please check all that apply)

* 15. Comments

T