NBTA Student Honourary Application

Please note:

Use standard upper and lower case typing format (e.g., John Smith). Do not use all upper case or lower case. Have questions or need support? Contact Administrative Assistant - Communications or call (506) 452-1833.

Personal Information
Date of Birth:	Month January February March April May June July August September October November December / Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year (YYYY)
First Initial: Only put an initial if actual birth name is NOT used. Example: A. Jane Doe
First Name:
Preferred First Name:
Second Initial: Example: Jane A. Doe
Last Name:
Birth Surname:
Mailing Address: Including Apartment Number
City/Town:
Home Province or State	Please select Home Province or State ----CANADA---- Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ----USA---- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Postal Code/Zip Code:
Preferred Phone:	- -
Cell Phone:	- -
Email Address:
Where is your permanent residence?	Please select Permanent Residence ----CANADA---- Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ----USA---- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming ----INTERNATIONAL---- Other Community (optional):
Council Automatic Enrollment
Council Membership:	Please select your council choice Elementary Middle Level High School
Student Information
Student Number:
University:	Select University Crandall University St. Thomas University University of New Brunswick
Month and Year of Graduation:	Month January February March April May June July August September October November December / Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034
Are you currently certified to teach in a province in Canada?	Answer: Yes No Where?
Did you have any teaching experience prior to entering your current program?	Answer: Yes No Where?