NBPTS Certification and Renewals Request

NBPTS Certification and Renewals Reimbursement Request

This form is for Chapel Hill-Carrboro City Schools teachers and nurses to request PSF Teachers First fund assistance for National Board Professional Teaching Standards Certification and Renewals.

Your Information
Name*
First Last
Mailing Address*
Where your reimbursement check should be mailed.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Choose Your School*
Your position
Indicate the certification for which you are requesting assistance.*
The amount indicated in parenthesis is the amount of assistance PSF offers.
- NBPTS Initial Certification - Component Payment ($475)
- NBPTS Initial Certification completion ($525)
- NBPTS 5 year renewal ($250)
- Nurses Initial Certification ($180)
- Nurses Renewal ($125)
Consent*
Check this box to certify and consent to the following terms
The teacher completing this form certifies that they are a teacher or school nurse in the Chapel Hill-Carrboro City Schools (CHCCS) district. Furthermore, the teacher/nurse agrees they will continue to teach in CHCCS for two full years after receiving certification/renewal. In the event any of these conditions are not met, the teacher agrees to repay assistance provided by the Chapel Hill-Carrboro Public School Foundation within 30 days of leaving the school district.
Required Attachments
Proof of Payment
Please attached receipts. For Initial Certification Component payment, receipt must show full payment of at least one of the four components.
Max. file size: 50 MB.
Completion Letter
Max. file size: 50 MB.
To receive your second payment for initial certification, please provide a copy successful completion letter from NBPTS stating you completed all requirements.

NBPTS Certification and Renewals Reimbursement Request

Your Information

Required Attachments