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* 1. First Name

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* 2. Surname

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* 3. Email Address

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* 4. Mobile Phone Number

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* 5. School Name

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* 6. School Address

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* 7. School Roll Number

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* 8. Home Address

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* 9. Are you a Teaching or Administrative Principal?

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* 10. Is your School DEIS or Non-DEIS?

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* 11. Please tick all relevant boxes to your school context

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* 12. Do you have an autism class in your school?

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* 13. Do you have a special class of any type in your school?

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* 14. Number of class teachers in your school

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* 15. Number of years you have served in teaching

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* 16. Have you significant experience as a teacher or principal in any of the following contexts?

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* 17. Number of years you have served as a principal: (Describe each context you have served in as principal and state whether you were teaching or administrative in each position

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* 18. Number of years as a deputy principal if applicable: Describe each context you have served in as deputy principal and state whether you were teaching or administrative in each position

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* 19. If retired, please state the date of your retirement

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* 20. I can commit to attending two Professional Learning Sessions and training dates as booked
(Please tick only one of the following)

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* 21. I can commit to:

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* 22. I can commit to commencing the CSL Coaching Support by December 2019

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* 23. I would like to be a mentor because:

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* 24. Do you have a qualification in mentoring or coaching?

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* 25. I have a particular expertise/experience in the following areas:
(Please tick all boxes which apply)

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* 26. An mbeadh suim agat bheith ag obair le príomhoide nua ó Ghaelscoil nó ó Scoil Ghaeltachta?

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* 27. Can you give one example of how you have to date built the leadership capacity of your own staff?

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* 28. Have you worked collaboratively with other schools on a leadership project?

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* 29. Are you involved in system support for school leaders?

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* 30. Anything else you would like to add?

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