Student Evaluations Registration Form

Today's Date * +

Teacher Name *

Is teacher an MTNA member? *

Yes

No (+$30 surcharge per student)

MTNA Number *

Teacher E-Mail Address *

MTNA Member: How many students in each level? 🛈

	Level Prep ($55)
	Level 1 ($55)
	Level 2 ($55)
	Level 3 ($55)
	Level 4 ($55)
	Level 5 ($70)
	Level 6 ($70)
	Level 7 ($70)
	Level 8 ($70)
	Level 9 ($70)
	Level 10 ($70)
	Level 11 ($85)
	Level 12 ($85)

Non-MTNA Member: How many students in each level? 🛈

	Level Prep ($85)
	Level 1 ($85)
	Level 2 ($85)
	Level 3 ($85)
	Level 4 ($85)
	Level 5 ($100)
	Level 6 ($100)
	Level 7 ($100)
	Level 8 ($100)
	Level 9 ($100)
	Level 10 ($100)
	Level 11 ($115)
	Level 12 ($115)

Total Fees:

$0.00

There are no refunds once submitted.

Please read the Teacher Work Requirements below.

Half day if entering 3 or fewer students.
Full day if entering 4-10 students.
Additional full day if entering 11+ students: Teacher will work a full day and provide an additional worker OR work extra hours pre- or post-event, as directed by the Chair.

The penalty for not meeting the work requirements is: $200 for half-day and $400 for full-day. Test results will be withheld until the penalty is paid. *

Yes, I agree to the Teacher Work Requirements.