NATA Application for Certification

Please fill out all sections of this form. Thank you!

Today's Date *
I joined NATA in: Month/Date/Year
First Name *
Last Name *
Home Address *
Home City *
State *
Zip Code *
Congregation: *
Cong. Street Address
Cong. City
Zipcode *
Work phone *
Professional Experience: List all positions, exact dates of employment and job titles. *
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Education: a) List name of institution(s), degree(s) or diploma(s) earned together with date(s). b) List courses in Jewish studies and/or Jewish Communal Service together with name of Institution(s), date(s), and credits or certificate(s) granted. *
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List any additional data, statements and/or job descriptions which you believe will assist in determining your eligibility. *
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CANDIDATE'S AGREEMENT I hereby apply to the Board of Certification for Temple Administrators for examination in accordance with its rules and requirements and enclose the application fee of $50.00 (payable to NATA, P.O. Box 418, Montvale, NJ 07645), which is non-refundable unless I am rejected for examination. I also agree that prior to or subsequent to my examination; the Board may investigate my standing as a Temple Administrator, including my reputation for complying with the NATA Code of Ethics.

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