Application Formforprimarydeissspschools

FRIENDSProgrammes

Application FormforPrimaryDEISSSPSchools

The closing date for receipt of applications is 5 pm on 23 October 2017. Applications must be signed by the principal and scanned and emailed to .

CourseVenue: / Dublin West Education Centre
Dates: / 12 & 13 December 2017
Time: / From / 9.30 am / To / 3.30 pm
Group Leaders:
SchoolName:
RollNo:
DEISStatus: / Urban 1 / Urban 2 / Rural
Principal:
Telephone: / Landline / Mobile
Email:

No.of Placesbeingsought:

ApplicantDetails-Teachersattendingmustbepermanentemployeesof theschool

TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email
TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email
TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email
TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email
TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email
TeacherName:
TeacherNo.
Position in School(ClassTeacher,SET,Principaletc.)
Class/ClassGroups
Email

Principal/TeachersCommitment

I/weunderstandthatteachersattendingthiscourseneedtobeabletocommittoattending forthefullday oneachofthe2daysinordertosuccessfullycompletethetraining andbe registeredwithFRasacertifiedfacilitator.

I/weunderstandthatFriendsResilience(FR)nolongerallowsmanualsoractivitybooksto be distributed at training. Manuals and activity books will be available to view during training.

I/weunderstand that following training, teachers arerequiredtocompleteateacher informationform for NEPS and a form of undertaking required by FR. See sample forms pages3and4.Onlya teachername,uniqueidentifiernumber,programmestrainedin,anda scannedcopyoftheformofundertakingwillbe shared by NEPS with FR. This willallow teacherstoregisteron-lineascertifiedfacilitators with Friends Resilience. Registration is required to be able to purchaseprogrammematerialsforfacilitatorsand their pupils.

Ourschoolwillsupportteacherswhoarecertifiedfacilitatorstodelivertheprogrammewith fidelity.

Pleasetickthattheprincipaland allteacherswhoareseekingplaceson this programmehave read and committotheabove

FriendsProgrammes–NEPSNationalDatabase

ted

Consent:

1.Igivepermission for theabovedetailstobeenteredon toaNEPSNationalDatabaseof accredited

FRIENDSfacilitators inIreland.

2.IfyouwouldlikeNEPStocontact youusingyour personalemailfor thepurposesofprovidingup- dates inrelation toNEPSFriendstrainingor researchbeingconductedbyNEPSinrelationtothe FriendsProgramsplease indicateby tickinghere.

3.I understand thataccess toFRIENDSmaterials islimitedtoaccredited facilitatorsregisteredon the FriendsResilienceDatabase.Therefore, Iagree to myname,uniqueidentifierno., programmescompletedandfinaldateof trainingtobesharedwithFriendsResiliencePTYLtd. Thisdatais supplied for thepurposeofregistrationasanaccreditedFacilitator of theaboveprogrammes inwhichI have trainedand for noother purpose.

The informationprovidedherewillbeheldbyNEPS,andprocessed inaccordancewith theDataProtectionActs

1988and 2003 for thepurposes of internal activityrecording,workplanningandpreparationof statistical

information.Apersonhasaright torequestacopyof thepersonaldatarelatingtohim or her.

Bysigningthisform, THEUNDERSIGNEDconsenttothecollectionanduseofthe informationas described

Signed:

Date:

UNDERTAKINGFORFRIENDSFACILITSATOaRSmple

FriendsResiliencePtyLtd

ABN52112233566

POBox5699

WestEnd,Queensland4101,Australia

IOF

(TeacherName)(School

UndertaketoFRIENDSResiliencePtyLtdACN112233566that:

1. Iwill,ingoodfaithtocomply withallterms,conditions andpolciesoftheFRIENDS Resilience

Organisation.

2. IwilladheretothestructureoftheFRIENDSPrograms(includingbutnotlimitedtoFunFRIENDS, FRIENDSForLife,MyFRIENDSYouthandAdultResilience)(“Programs”) andthatIwilldeliver eachofthePrograms insequence, fromthefirsttothefinalsession infullcompletion ofeach program.

3. AsaFRIENDSfacilitatorIwillacquireanauthorisedcopyoftheFRIENDSbooksfromtheFriends ResilienceOrganisationonly.I understandthatI amnotauthorisedtoruntheProgramsfor commercialpurposes.

4. OneauthorisedcopyoftheworkbookwillbeobtainedforandprovidedtoeachProgramparticipant forthePrograminwhichtheyareparticipating.Theworkbooksarenottobereusedandaretobe keptbytheparticipantasaprivaterecordoftheirworkintheProgram.

5. IamaccreditedonlytodelivertheProgramsforaperiodofthreeyearsfromthedateoftraining.

6. IamonlyaccreditedtodelivertheProgramsunderacurrentLicenseAgreement.

Signature:

FullName:

UniqueIdentifyingNo:

FRIENDS Resilience PTY LTDACN112 233 566

POBOX5699,West End, QLD4101,Australia

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