Wider Circle Representative Designation Form

First Name *

Last Name *

Email *

Job Title *

Your role or professional title. 

Organization *

Your school name. 

Do you wish to nominate a new Wider Circle Representative? *

If your current Wider Circle Representative is continuing in their role, please let us know via the dropdown below.

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

First Name *

Last Name *

Job Title *

Email *

Additional Wider Circle Representatives *

In the following two exceptional cases, the school’s chief administrator may designate additional Wider Circle Representatives: a) in schools with multiple campuses, a member may be appointed for each campus; b) schools whose Wider Circle Representative also serves on the PDAC may select an additional faculty member to serve on the Wider Circle. 

Please note that only one Wider Circle Representative from any school group or system is eligible for the 50% NESA Educators Learning Event discount.

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

Enter required value Yes No

Additional Wider Circle Representative Details

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