National Board Certification Summer Jump Start 2025

I am attending the following session(s): If attending all sessions ONLY check ALL SESSIONS box *

ALL SESSIONS – ALL DAYS – NO NEED TO CHECK ANY OTHER BOXES ANY OTHER DAYS
Day One 7/22 – 9:00 a.m. – 10:00 a.m. Foundations 1 – Session 1
Day One 7/22 – 10:20 a.m. – 11:55 a.m. Foundations 1 – Session 2
Day One 7/22 – 1:05 p.m. – 2:05 p.m. Foundations 1 – Session 3
Day One 7/22 – 2:10 p.m. – 3:45 p.m. Component 1 – Content Knowledge – Session 1

I am attending the following sessions (on day 2):

Day 2 -7/23 – 9:00 a.m. -10:45 a.m. – Component 1: Content Knowledge – Session 2
Day 2 – 7/23 – 11:05 a.m. – 12:15 p.m. – Component 2 : Differentiation in Instruction – Session 1
Day 2 – 7/23 – 1:25 p.m. – 2:45 p.m. – Component 2 : Differentiation in Instruction – Session 2
Day 2 – 7/23 – 2:55 p.m. – 3:45 p.m. – Component 2 : Differentiation in Instruction – Session 3

I am attending the following sessions (on day 3):

Day 3 – 7/24 – 9:00 a.m. – 10:45 a.m. Component 3 Teaching Practice and Learning Environment – Session 1
Day 3 – 7/24 – 11:15 a.m. – 12:30 p.m. Component 3 Teaching Practice and Learning Environment – Session 2
Day 3 – 7/24 – 1:40 p.m. – 3:15 p.m. Component 4 Effective and Reflective Practitioner – Session 1

Are you interested in participating in our mentorship program? *

Yes
No

LEGAL Name *

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Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone *

Personal Email -this will be how we contact you with updates and information *

PLEASE MAKE SURE THIS INFORMATION IS ACCURATE OR YOU WILL NOT RECEIVE UPDATES

Local Association *

If other, specify below:

MSEA ID# *

Race/Ethnicity *

Gender *

Pronouns for Name Badge *

Self Description for Name Badge

Allergies/Dietary Restrictions

Please leave blank if NONE. Indicate if you have any environmental or food allergies that we should be aware of, e.g. nuts, dairy, gluten.

Is this your first-time attending an MSEA event? *

Yes
No

Is this your first-time attending NBC Jumpstart? *

Yes
No

CERTIFICATION AREA *

Accommodations and Special Requests

We are committed to providing an accessible event for all participants. If you require any accommodations due to a disability or have any special needs, please describe any necessary accommodations here or contact us directly to ensure that your needs may be met in this event. We will attempt to make every reasonable effort to accommodate your request.

Cancellation Policy

1. Cancellations must occur by NOON Friday, July 11, 2025. You may cancel by emailing [email protected]. If you do not cancel prior to this date, you will forgo any payment for the event and will be assessed any costs incurred by MSEA as a result of the late cancellation. Those costs will include food, venue, and trainers costs. The manager responsible for the event or the MSEA president may waive costs in the case of emergency with appropriate documentation. 2. Barring an emergency reason, cancellations by NOON Friday, July 11, 2025 or no-showing at an event will mean that any costs incurred by MSEA will be passed on to the attendee. 3. If you register after NOON Friday, July 11, 2025, we will be unable to refund hotel costs for any reason. Registration costs for this event are nonrefundable and nontransferable.

A/V Policy

Video and sound recording is prohibited at MSEA events.

Do you require hotel accommodations? *

Yes
No

Covered under MSEA travel criteria. MSEA will cover the first night

MSEA members staying 1 night will result in the cost of – $160.06

Hotel accommodations are available for those traveling 100 miles one-way or who need to leave home before 7:00 a.m. to arrive at the training on time. MSEA will provide a one-night hotel stay, and the member will be responsible for their second night at the rate of $160.06, which includes hotel taxes and a $25.00 hotel incidental fee. (Hotel accommodations are only available for participants needing them for the entire jumpstart event.) Participants MUST stay both nights and be willing to pay for the second night. Members that do not meet the MSEA travel guidelines are responsible for their own hotel accommodations.

Attendee Information

Attendee's Name – FOR NAME BADGE *

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Last

Pronouns for Name Badge *

Allergies

Please indicate if you have any environmental or food allergies that we should be aware of, e.g. nuts, dairy, gluten.

Total

$0.00

Stripe Credit Card *

Where

When