Deadline for applications: midday 27 November 2014

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* 1. Surname

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* 2. First Name

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* 3. Title

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* 4. Name of School

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* 5. Phase of School

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* 6. Email address - please note that ALL communication will be sent to you via email so please provide the address you view regularly

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* 7. Additional Email

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* 8. Mobile Number

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* 9. What is your ethnicity? (Please select all that apply)

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* 10. What is your gender?

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* 11. Your current role (eg. Head of School, Deputy Head, Assistant Head, Head of Year, etc.)

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* 12. Qualifications - I have completed

  Yes No
NPQSL
NPQML
NPQH

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* 13. Qualifications - please detail any other qualifications you hold

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* 14. Please indicate any particular training sessions, experiences or support you would like included within the programme

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* 15. Are you interested in applying to

  Yes No
a lead Special school?
a lead Primary school?
a lead Secondary school?
a school with a religious character?
a school in challenging circumstances?

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* 16. I confirm that I am committed to attending the sessions and have discussed with my Headteacher, who is supportive of my participation

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* 17. Please provide a brief overview of your career (ie. 10 bullet points), eg. number of years teaching, key roles including leadership roles to date, types of schools, previous employment outside teaching

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* 18. Please provide any further information which you think may help support your application

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* 19. Please tell us why you would like to be considered for this programme

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* 20. Please provide us with an idea of your short term career goals (this year)

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* 21. Please provide us with an idea of your medium term career goals (next 1-2 years)

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* 22. Please provide us with an idea of your long term career goals (next 5 years)

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* 23. What actions do you intend to take to promote or achieve the goals you have stated above?

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* 24. Please list your key strengths

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* 25. Please list the areas you feel you want or need to develop

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