Form Submitter/Contact Person Details

First Namerequired

Last Namerequired

Job Titlerequired

Email Addressrequired

Name of Schoolrequired

Will you be nominating a new Wider Circle Representative this year?

Yes No, our current Wider Circle Representative will continue in their role.

We look forward to our continued collaboration. Please click on the SUBMIT button to complete this form. Thank you!

Please provide contact information for your new Wider Circle Representative:

First Namerequired

Last Namerequired

Job Titlerequired

Email Addressrequired

In the following exceptional cases, the school’s chief administrator may designate additional Wider Circle representatives, though only one member from any school system is eligible for the 50% NESA Educators Learning Event discount:

In schools with multiple campuses, a member may be appointed for each campus.
Schools whose Wider Circle member also serves on the PDAC may select an additional faculty member to serve on the Wider Circle.

Our school meets the criteria and wishes to designate additional Wider Circle Representatives:

Yes No

Additional Wider Circle Representativesrequired

Please provide the full name(s), job title(s) and email address(es) of the additional Wider Circle Representative(s) you wish to nominate.