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Community Languages Induction Program K-6 (CLIP)

2016 APPLICATION FORM

Please read this application carefully and complete all sections.

  1. Personal information

Department ID number: / BOSTES teacher number(if applicable):
Title: / Given name(s):
Middle name:
Surname:
Home address:
Postcode:
Home phone: / Mobile:
Email:
Are you a new Languages teacher?
If yes, please indicate whether you are: / Yes No
a.Currently going through the accreditation process, or
b.Accredited with BOSTES / Year accredited:
  1. Employment details
  1. I haveDepartmental approval to teach as follows:

Full-time / Part-time
Primary / Secondary / If secondary, which subjects?
Permanent / Casual relief / Conditional casual
Temporary / Tutor status / Community languages only
  1. I am currently employed as follows:

Full-time / Part-time
Primary / Secondary / If secondary, which subjects?
Permanent / Casual relief / Conditional casual
Temporary / Tutor status / Community languages only

How long have you been teaching your language in NSW primary schools? ______

How long have you been teaching in Australia? ______

How long had you been teaching overseas? ______

  1. Main school details

Note: If you teach at more than one school from Monday to Friday, you will need to select one school as your main school for the purposes of this application.

Name of School: / School code:
Name of Principal:
School Address:
Postcode:
School phone: / School fax:
Which community languages do you teach?
Which year level(s) do you teach?
  1. 2016 timetable

Please complete the following table. For each teaching allocation, indicate whether you are teaching a community language, mainstream primary, ESL, other.

Day / School / Principal / Teaching allocation
Mon
Tues
Wed
Thurs
Fri

Indicate if your students are:

All background speakers / Mostly background speakers
All non-background speakers / Mostly non-background speakers
  1. Tertiary qualifications and awards

Qualification / University/College/Institute / Specialisation / Subject (if applicable) / Year completed
Give details of any other awards, grants or scholarships you have received for professional development from the Department or from other organisations in the last five years?
  1. If you have previously participated in the Community Languages Induction Program K-6, please indicate year attended. ______
  2. Explain why you want to participate in the Community Languages Induction ProgramK-6.

Applicant’s signature: / Date:
  1. Approval of Principal(s)

Applications to attend the Community Languages Induction Program K-6 are subject to the approval of the school principal. If you teach in more than one school, it is necessary to obtain the approval of all principals.

School:
Principal’s name:
Principal’s signature: / Date:
School:
Principal’s name:
Principal’s signature: / Date:
School:
Principal’s name:
Principal’s signature: / Date:
School:
Principal’s name:
Principal’s signature: / Date:
  1. Attending Principal’s section

Principals attending the CLIP workshop on Thursday 10 March 2016 with their Community Languages teachers are asked to complete the following section.

Was the community language program first implemented in your school in 2016? / YesNo
If no, when was the community languages program implemented in your school?
Are you a new principal in a school with an established community language program? / YesNo
Briefly describe the community language program at your school (e.g. withdrawal, team teaching, RFF component, immersion, integration across the curriculum, etc.).
If you are a teaching principal, please tick the appropriate box:
I do not require relief / I do require relief
Signature: / Date:
  1. Other attending staff member’s section

If the principal is unable to attend but would like to nominate another executive member of staff to attend, please provide the following details.

Name of attending staff member:
Position:
Please tick the appropriate box:
I do not require relief / I do require relief.
Signature: / Date:

Please return the completed and signed application (preferably via email) to

Sana Zreika
K-6 Languages, Community Program Officer
Early Learning and Primary Education

Level 3, 1 Oxford Street, Darlinghurst NSW 2010
Phone: 9244 5261Fax: 9266 8098

Closing date for applications: Friday4 March 2016

PUBLIC SCHOOLS NSW – Early learning and primary education / / 1/4