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Complete this form if you have changed your name or address. If you change your name due to marriage, please attach a copy of your marriage license.
Dependent Student Semester Verification Form
Complete this form, each semester, for your dependent post-secondary student.
Proposed Orthodontic Treatment
Have your orthodontist complete this form before any treatment has begun.
Clarification Of Orthodontic Treatment
Have your orthodontist complete this form once banding is complete.
Board of Trustees
Board of Trustees of the Newburgh Teachers’ Association Benefit Trust Fund
NTA BTF Premium Schedule
Retired teachers must join the NTA retiree chapter and pay $50 dues to be eligible for Trust Fund Benefits. Retired Teaching Assistants must join the NTA retiree chapter as “social members” and pay $25 dues
Non-Participating Provider Vision Claim Form
Out of Network vision provider form for reimbursement