NFA Member Application

NFA Membership Application

NSHE Full-Time Professionals
You have reached an outdated version of the NFA membership application form. Please visit https://form.jotform.com/242675325038155 for the current application form.

NFA is the independent association of faculty in Nevada since 1983, affiliated with the American Association of University Professors ("AAUP") and the American Federation of Teachers ("AFT"). We work to empower faculty to be fully engaged in our mission to help students succeed. We advocate for academic freedom and faculty employee rights. For further information: http://www.nevadafacultyalliance.org/

NOTE: This application form is for NSHE professional employees at 0.5 FTE or higher. For part-time faculty, retirees, and other individuals not eligible for payroll deduction, please use our Partners and Allies Application.

This form is securely hosted by Jotform.com
Applicant Information
Name*

First NameLast Name
Institution*
Institution Approver*
Department*
Mobile/Personal Phone Number
*By providing my cellular phone, I understand that NFA, AAUP and the AFT may use automated calling techniques and/or text message me on mycellular phone on a periodic basis. NFA, AAUP and AFT will never charge for text message alerts. Carrier message and data rules may apply to suchalters.
Work Phone Number
Optional
Personal Email*

Confirmation EmailFor NFA website login and emails, shared only with AAUP and AFT.
Work Email*

Confirmation Email
Residential Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing address is the same as street address
Mailing Address

Mailing Address

Mailing Address 2

CityState

Zip Code

Enrollment

Yes - I want to join my fellow employees and become a member of the {institution139} chapter of the Nevada Faculty Alliance, the American Association of University Professors, and the American Federation of Teachers.
DRI Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with Desert Research Institute.
GBC Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with Great Basin College.
NSU Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with Nevada State University.
UNLV Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with University of Nevada, Las Vegas.
UNR Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with University of Nevada, Reno.
Chapter Type & Job Classification*
Authorization*
Monthly Dues*
NFA pays AAUP dues on the member's behalf
NFA-PAC Contribution
Additional Contribution
Total Monthly Contribution

Monthly Payroll Deduction:

Dues:	{monthlyDues}
NFA-PAC Contribution:	{nfapacContribution}
Additional Contribution:	{additionalContribution124}
Total Monthly Deduction:	{totalMonthly}

Signature*

Powered by Jotform SignClear
Date*

MonthDayYear

I hereby authorize the Nevada System of Higher Education to deduct from my salary and to pay the Nevada Faculty Alliance the agreed monthly payroll deduction of {totalMonthly} as NFA professional dues for the current membership year and each year thereafter. I fully understand that the annual dues, fees, and assessments required in the three associations are subject to periodic change by the governing bodies of the association and authorize NSHE to deduct any modified monthly dues, fees, and assessments established by the governing bodies of the three associations, unless my obligation to do so ends under one of the circumstances set forth here. This authorization supersedes any previous payroll deduction for NFA. This authorization continues from year to year, regardless of my membership status, unless altered by a new payroll deduction or I (a) revoke this authorization in a signed writing sent to my campus payroll office and by sending e-mail notice to the NFA at admin@nevadafacultyalliance.org between July 1-15, of the membership year immediately preceding the membership for which the authorization is to be revoked, or (b) my employment with NSHE ends.
Employee Name

{name}
NSHE Employee ID Number*
May be found on employee pay slip in Workday
Please use the 9-digit employee number from your profile in Workday. You may also find your Employee ID number on your pay slip,

Click Here!

X

NSHE employee pay slip information
Employee Signature*

Powered by Jotform SignClear
Date*

MonthDayYear
NFA Email*
example@example.com
Approver*
example@example.com
Please verify that you are human*
Should be Empty:

NFA Membership Application

Enrollment

Monthly Payroll Deduction:

Employee Name