NPQML APPLICATION FORM – East Midlands applicants only

Personal information
First name / Surname / DOB
Email address
Teacher reference number / Ethnic Origin / Phone Number
This should be in the format 00/00000.
If you don’t know yours, click here to find out, / Choose an item. /
Please inform us if you have any access requirements
Would you consider yourself as having a disability? / If yes, please let us know any special requirements you may have:
Yes ☐ No ☐
Do you have any dietary requirements? / If yes, please state details:
Yes ☐ No ☐
Town you live in (so we can place you in the right cohort).
Role in school
School Information
School name
Street address 1
Street address 2
Post code / Ofsted rating / Ofsted date
School type / School phase / Number on roll
Choose an item. / Choose an item. /
School Unique Reference Number / Local Authority (geographical location) / 30% of pupils are eligible for FSM
Yes ☐ No ☐
If you are a member of a Multi Academy Trust, please name it here: / If you are a member of a teaching school alliance, please name it here: / If you are a category 5/6 or opportunity area, please state which one here:
Email address to send invoice to: / If a purchase order (PO) is required, please ensure this is arranged prior to submitting your application form.
Headteacher name / PO number, if appropriate
Headteacher email address
Assessment section
To be completed by the participant
I agree to complete NPQML including 6 face to face days and submission at final assessment / Yes ☐ No ☐
I am aware that my data will be shared with key partners in connection with NPQMLin accordance with the Inspiring Leaders privacy notice. / Yes ☐ No ☐
I am happy for my photo to be taken at some face to face days which may be used in marketing materials such as the Inspiring Leaders website, flyers, prospectus and Twitter. Should my circumstances change, it is my responsibility to withdraw permission for the use of personal data (outside the statutory requirements) by Inspiring Leaders / Yes ☐ No ☐
Please briefly state any current leadership responsibilities you have including examples of how you have contributed to the improvement of teaching or outcomes for pupils (200 words)
Please outline your next stage career aspirations, the timeline in which you aim to achieve this and how this qualification will support you to realise this. (200 words)
To be completed by the Headteacher
I have agreed to support this application for NPQML / Yes ☐ No ☐
I have agreed to release the applicant for 6.5 days of training / Yes ☐ No ☐
I will ensure the applicant is provided with a coach in school to support their study / Yes ☐ No ☐
I will ensure the application is provided with sufficient opportunities, stretch and challenge in order to complete the assessment task in school / Yes ☐ No ☐
Please provide a brief statement as why NPQML has been chosen to support the applicant’s professional development (200 words)

Please submit this application form to

Boxes marked with an * are a requirement and your booking form may not be considered without completion of these.