REGISTRATION FORM
National Professional Qualification in Middle Leadership Level 1
2017
LSSW NPQML Level 1 - Application Form Intake 7 - 2017
Please complete this form in ink using BLOCK CAPITALS where appropriate. Please make sure that we receive all the information specified otherwise we will not be able to submit your application. Information regarding your school can be found online at EduBase which is accessible at education.gov.uk/edubase/. It is particularly important that we receive your seven-digit Teacher reference number and the six-digit Unique Reference Number (URN) for your establishment, and that all information you provide is as accurate.
*All fields are mandatory, failure to complete will result in your application being rejected.
PERSONAL INFORMATION*First Names (given at birth and legally known as) / *Gender (F/M)
*Surname / Asgiven on Qualified Teacher Status certificate / *Previous Surname
if applicable
*Home Address
*Postcode
*Telephone no. / *Ethnic Group / e.g. WHITE BRITISH
*Mobile no. / *Date of birth / D / D / M / M / Y / Y / Y / Y
*Personal Email
(to which all NPQML matters will be addressed) / *Do you consider yourself to have a disability? YES / NO (Delete as appropriate)
If YES please include information with your application
*Dietary Requirements & Allergies
SCHOOL INFORMATION – Please see EduBase website for school information and guidance
*School Name & Address
*Postcode
*Work Email / For contacting you personally at school
*Telephone no. / *Mobile no.
*Local Authority / *Phase / e.g. SECONDARY
*Establishment Type / e.g. FOUNDATION SCHOOL / *School URN
*Number of pupils on roll (2015 PLASC) / *Teacher Ref. Number
*Current School Role Title / *Date of Appointment / D / D / M / M / Y / Y / Y / Y
*Brief description of participant’s current role, including areas of responsibility
*To be completed by Line Manager / Headteacher
Please give brief statement to support the application
School Accounts/Finance Officer Email Address: ……………………………………………………………
Headteacher Email Address: …………………………………………………………..
I agree to pay programme costs as shown. Please note: we do not accept typed signatures
Signed: ...... Print Name: ......
School Role: ......
*Please confirm that you have read and accept LSSW’s Cancellation
Policy by ticking the box.
Fees and Scholarships
NCTL guideline cost / LSSW scholarships are based on 2016 Spring PLASC returns for your school / Total Payable
£998 / Full Cost / Full cost of the programme without scholarship / £998
LSSW scholarship £100 / Primary schools with 101 - 250 pupils on roll / £898
LSSW scholarship £200 / Primary schools with 100 pupils or less on roll / £798
** Applicants not employed in a school, or employed in an independent school, non-maintained school or an organisation outside England are not eligible for funding and are required to pay £998 per applicant. Those who apply from independent and non-maintained schools or schools from outside England will also need to pay £225 for their final assessment, making the total cost £1223.
Please ensure this form is complete as the information is used by LSSW and National College to verify any applicable funding. Please return this form to LSSW Admin Team:
/ Leading Schools South West,
Victoria Commercial Buildings,
Beacon Place,
Station Approach,
Roche,
PL26 8LG
LSSW NPQML Level 1 - Application Form Intake 7 - 2017