APPOINTMENT OF GOVERNOR TO GOVERNING BODY

Please ensure all sections marked with a * are completed

NAME OF SCHOOL*
NAME OF NEW GOVERNOR *
(First name and Surname)
TITLE (MR/MRS/MISS/MS etc.)*
TYPE OF GOVERNOR *
(e.g. Parent / Co-opted / Partnership / Sponsor / Foundation etc.)
ADDRESS OF NEW GOVERNOR* (Preferred mailing address)
POSTCODE*
TELEPHONE NUMBER
EMAIL ADDRESS
(Provision of email helps us to communicate rapidly with Governors.)
DATE APPOINTED *
(We are unable to process the appointment if this date is omitted)
DATE OF BIRTH *

.

EQUALITY MONITORING*

(Please indicate as appropriate. This information is used for monitoring and statistical purposes to help us improve community representation, and address any inequalities in our service).

WHITE: / BRITISH / IRISH / OTHER
ASIAN OR ASIAN BRITISH: / INDIAN / PAKISTANI
BANGLADESHI / OTHER ASIAN
MIXED: / WHITE AND BLACK CARIBBEAN / WHITE AND ASIAN
WHITE AND BLACK AFRICAN / ANY OTHER MIXED BACKGROUND
BLACK OR BLACK BRITISH: / CARIBBEAN / AFRICAN
ANY OTHER BLACK BACKGROUND
CHINESE: / OTHER ETHNIC GROUP:

DO YOU CONSIDER THAT YOU HAVE A LONG TERM CONDITION, IMPAIRMENT OR DISABILITY THAT SIGNIFICANTLY AFFECTS YOUR DAY TO DAY ACTIVITIES?

(Disability Discrimination Act (DDA) 2005)

YES / NO

IF YES WHICH CATEGORY DOES THE DISABILITY FALL WITHIN?

MOBILITY IMPAIRMENT
VISUAL IMPAIRMENT
HEARING IMPAIRMENT
OTHER

PLEASE SPECIFY …………………………………………………………………………

GENDER
NAME OF CLERK
DATE

PLEASE RETURN TO:

Email:

GOVERNOR SERVICES

EES for Schools

1ST FLOOR

SEAX HOUSE

VICTORIA ROAD SOUTH

CHELMSFORD

ESSEX CM1 1QH

Telephone enquiries: 033301 30768

Please note: The personal information you provide to Essex County Council will be used and shared only in connection with your role as a school governor and in accordance with Data Protection Act 1998. We maintain a register of School Governors and may send you information on the role of governors or training courses available.

Revised August 2015 EES for Schools is owned by Essex County Council