Candidate Subsidy Program
Withdrawal Form
Dear Candidate:
Upon notifying the National Board for Professional Teaching Standards (NBPTS) of your withdrawal from the NBPTS Certification Program, please complete the form below and return it to the California Department of Education.
Your timely response will ensure that we will be able to transfer your fee subsidy to another candidate.
Mail to:
Juliet Barbero , Analyst
Administrative and Fiscal Services Unit
California Department
of Education
1430 N Street, Suite 4309
Sacramento, CA 95814
Fax to: (916) 323-2806
CERTIFICATION: (please print your name)
I, _______________________________ have withdrawn from the National Board for Professional Teaching Standards Program. Please remove my name from the California Candidate Subsidy Program list. I understand by signing this form, I may still be considered for future subsidy funding, pending state budget approval.
________________________
Signature
________________________
Date
