Secondary Schools
Regional Associate Nomination/Renewal Form
Individuals wishing to become Regional associates should fill out the entire Regional Associate Nomination Form. The form can be printed off, filled out, and returned to the Department or individuals can fill out the form below and submit it electronically.
Individuals wishing to renew their application as a Regional Associate need only fill out the fields marked by an asterisk.
Check this box IF this is a renewal. Initial applications should ignore this field.
Nominee Information:
* Enter Your Full Name: (prefix, first name, last name, and suffix. Please include community initials in the suffix.)
* Enter Your Position:
* Enter Your Institution:
* Enter Your Street Address:
* Enter Your Address Continuation, if any:
* Enter Your City:
* Enter Your State:
* Enter Your ZIP Code:
* Enter Your Home Phone:
* Enter Your Work Phone:
* Enter Your Fax Number:
*Enter Your Email Address:
Enter the complete URL of your school website, if you have one:
What is your educational background?
What is your teaching and administrative experience?
What other educational experience do you possess?
* Are you a member of NCEA or affiliated with an institution that is a member of NCEA? Yes No
* Enter your or your institution's member ID Number (Refer to the upper left corner of an NCEA mailing label [sample below] )
* Are you planning to remain in Catholic education for the next three years? Yes No`
Comments:
* Would you be willing to serve on the Executive Committee? Yes No
* Will you attend Regional Meetings of NCEA as possible? Yes No
* Will you attend NCEA conventions as possible? Yes No
Please list names and addresses of two other Catholic educators who could provide references:
Name/Position/Institution/Address/City/State/ZIP Code/Country/Office Phone/Home Phone/Fax/Email for Reference 1
Name/Position/Institution/Address/City/State/ZIP Code/Country/Office Phone/Home Phone/Fax/Email for Reference 2
Nominations can be submitted any time and will be accepted and kept on file, but will be processed annually in October.
Note: Please do not duplicate this on-line nomination with a printed/mailed or faxed version of the HTML based form.
Once submitted, the information on this form will be emailed to the Secondary Schools Department at NCEA. A confirmation form will appear on your screen when the form has been submitted and you may print the confirmation for your records. Thank you for your participation!