L E A P

Leading Educators Around the Planet Pty Ltd

ABN 13 134043851

International Peer Shadowing Leadership Program for Educational Leaders

International Membership Form 2018

(For applicants from outside of Australia)

  1. Download this form.
  2. Complete this Membership Matching Profile Form for internationalapplicants (pp1-6) and return electronically as an attached WORD doc (this Matching Profile will be shared with your Australian partner). Please ensure that you complete page 6 regarding your Personal Obligations.
  3. Retain a full copy of your application.

Matching Profile/Membership Application Form Contents:

Section 1: Program Profile (Page 2)

Section 2: School/Work Profile (Page 3)

Section 3: Personal Profile (Page 4)

Section 4: Program Expectations and Dates (Page 5)

Section 5: Personal Obligations (Page 6)

Section 6: Program Summary (Page 7)

SECTION 1: PROGRAM PROFILE

  1. Please indicate your name:______
  1. Please indicate your current position:

Principal/Head Teacher/Administrator

Deputy Principal/Vice Principal/Deputy Head

School Director/Superintendent

Non-School Based position:______

  1. Please indicate your home location:

Canada:

  • New Brunswick
  • British Columbia

England:

  • South Gloucestershire
  • Nottinghamshire

Scotland

Ireland

USA:

  • Alabama

Finland

Other: ______

SECTION 2:SCHOOL/WORK PROFILE

School/Work Place: ______

School/Work Place address: ______

______

Work Contact details:

Mobile-

Phone-

Email-

School/Work Place profile:

Please include specific school information (e.g. classification; enrolment numbers; special programs; geographic location; special education units; student and staff profiles); or specific Work Place description if non school-based environment.

Professional history:

(Please include any relevant research, awards, professional associations, years in the principalship and/or current position;principal association involvement; qualifications & other relevant experiences etc.)

SECTION 3: PERSONAL PROFILE

Name: ______Please insert portrait

photo here.

Age: ______

Gender: ______

Personal phone contact: ______

Home address: ______

______

  1. Family Profile:
  1. Accommodation Profile:

(Please include: any pets you may have; bedrooms available, bathrooms available etc.)

  1. Accompanying travellers:

Is your spouse/partner planning to be travelling with you? Yes/No

The conditions for a spouse/partner travelling are:

  • This arrangement must be suitable to and agreed to your host
  • The spouse/partner is not a part of the LEAP educational program and must be self-reliant during the period of the educational program
  • The spouse/partner is welcomed to participate in all aspects of the LEAP social program (some of which will have a cost associated)
  1. Allergies & Special Dietary Requirements

Do you have any allergies? Yes/No

If "Yes" please give details:

Any special dietary requirements

  1. Personal hobbies and interests:

SECTION 4: PROGRAM EXPECTATIONS

Reciprocal membership fee of the 2018 LEAPProgram is AUS$550 (cash) on arrival.

As a participant in LEAP 2018, I undertake to participate in all phases of the LEAP program. Please read each phase carefully.

Preparation Phase:

Submission of my LEAP International membership application (this form)

Communication (e.g. email) with LEAP (NSW) coordinators

Matching by LEAP coordinators with a LEAP (NSW)international colleague

Communication (e.g. email) with LEAP (NSW) international colleague

Phase 1:

Membership of LEAP 2018 will provide:billeting and hosting with my Australian colleague from 22ndJuly - 1stAugustand access totheLEAP peer-shadowing and professional learning experience with my international colleaguefrom 22ndJuly –1stAugust

Membership of LEAP 2018 will involve attendance at the following events with my Australian colleague.

  • The Welcome Luncheon Seminar (Sunday 22ndJuly)
  • The Schools Visitation Program (Locally arranged).
  • The LEAP NSW International Conference(Wednesday 1stAugust)

Phase 2:

Billeting and hosting of my Australian colleagueat my home and school from Sunday30th September until Wednesday 10th October

Engaging in a Welcome function for my Australian colleague (Sunday 30thSeptember)

Facilitating appropriate peer-shadowing, educational and professional learning experiences for my Australian colleague from Sunday30th September until Wednesday 10th October

Engaging in a Farewell function (Wednesday 10th October)

SECTION 5: PERSONAL OBLIGATION

Membership fee is AUD $550.00 and is payable by cash in $AUD to the Director of LEAP (NSW) at the commencement of the program in New South Wales.

Membership application:

I hereby apply for Reciprocal Membership of LEAP for 2018 according to the conditions of the program outlined above. I agree to pay, on arrival in Australia,$550.00 AUD in cash

I acknowledge that all costs associated with my travel, travel insurance, additional accommodation (excluding billeting), personal and incidental costs etc are not covered by the membership, and that they are my own personal responsibility(as per LEAP Membership Obligations 2018 Form).

Name Signed Date

LEAP NSW:

Directors: Sue Lazenby and Warren Marks

Phone: +61 24889 8696

Mobiles: +61 412 049 637; +61 412 960 108

E-mail:

Postal address:

LEAP,

P.O. Box 71,

Hill Top,

NSW 2575

Australia

L E A P (NSW)

Leading Educators Around the Planet Pty Ltd

ACN 134043851

SECTION 6: PROGRAM SUMMARY

In addition to a professionally matched international educational leadership partner (for the duration of the program) LEAPReciprocal Membership fee for 2018 ($550 AUD) provides funded attendance at:

  • LEAP Welcome Luncheon Seminar –Sunday 22ndJuly 2018
  • LEAPSchools Visitation Program – Locally arranged
  • LEAPInternationalConference – Wednesday 1stAugust 2018
  • LEAPFarewell Dinner Seminar – Wednesday 1stAugust 2018

NB: This membership fee is solely related to the activities listed above. All travel costs; travel insurance and health costs; billeting expenses; additional accommodation costs; hospitality costs; or any personal and incidental costs associated with being involved in LEAP2018 are the personal responsibility of the participant. Please retain this page (Section 6) for your own records (and potentially for your country’staxation purposes).

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