National Board Certification Winter Jump Start 2026

I am attending the following session(s): *

All Sessions (except MOC) – Please do not check any other boxes
Day 1 – 1/9 – 5:30 p.m. – 8:00 p.m. – General Session- process, requirements, timelines, and scaffolding standards
Day 2 – 1/10 – 9:15 a.m. – 10:00 a.m. Component 1: Content Knowledge Portfolio
Day 2 – 1/10 – 10:00 a.m. – 12:00 p.m.- Component 1 Component 3 (Simultaneously, two separate sessions)
Day 2 – 1/10 – 1:00 p.m. – 3:15 p.m.- Component 1 Component 3 (Simultaneously, two separate sessions)
Day 2 – 1/10 – 3:15 p.m. – 3:45 p.m. – Q &A and Feedback
Day 2 – 1/10 – 9:00 a.m. – 1:00 p.m. MOC ONLY (current MBCT’s up for renewal)

Are you interested in participating in our mentorship program? *

Yes
No

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone *

Personal Email – NOT your work email *

This is where you will receive our communications. Work emails can sometimes block our communications.

Local Association *

Allergies/Dietary you Acknowledgement

If other, specify below:

MSEA ID# *

If you do not know your MSEA # please email [email protected]

Race/Ethnicity *

Gender *

Pronouns for Name Badge *

Allergies/Dietary Restrictions *

LEAVE BLANK IF NONE – Please 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 – PLEASE READ CAREFULLY

1. Cancellations must occur by NOON, Friday, December 19, 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. 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, December 19, 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 December 19, 2025 we will be unable to refund hotel costs for any reason. The cost billed to no-show members last Jump Start was $93.86. This cost will change as our hotel food costs change.

Acknowledgement of cancellation policy *

I have read and understand the cancellation policy.

A/V Policy

Video and sound recording is prohibited at MSEA events.

Do you require hotel accomodations? *

Yes
No

NBC Fall Jump Start 2025 Hotel Costs *

Hotel Room Cost – $134.47

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 at the rate of $134.47, 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.) Members that do not meet the MSEA travel guidelines are responsible for their own hotel accommodations. This cos is non-refundable due to direct billing with the hotel.

Stripe Credit Card *

Total

$0.00

Where

When

Accommodations and Special Requests

Cancellation Policy – PLEASE READ CAREFULLY

A/V Policy