Teacher Lifetime Application

National Private School Association

Application for Lifetime Educator’s License

Name
____________________________________________________________________
(Last) (First) (Initial) (Maiden)
Social Security Number ____________________
Date of Birth ____________________
Home Address
_____________________________________________________________
(Street/Box)                (City, State)                (Zip)

NPSA School:
______________________________________________________________
All applicants must hold a current NPSA Educator License.

OPTION 1: 55 YEARS OF AGE OR OLDER
I attest that I am eligible for a Lifetime NPSA Educator License based on the
fact that I am 55 years of age or older.

Signature _____________________________ Date __________________

OPTION 2: 25 YEARS TEACHING EXPERIENCE
List below the school(s) and years of service in which you obtained your 25
years of teaching experience. Verification of experience outside the NPSA
must be attached.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
I attest that I am eligible for a lifetime educator license based upon 25 years of
teaching experience.

Signature _____________________________ Date __________________
The National Private School Association offers certification to all eligible candidates who are employed by member schools without
discrimination in regard to sex, race, religion, physical handicaps, color or natural origin.
National Private School Association