NPQML

Application Form and

Referenceand

Commitment of Support

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The Professional AllianceBirmingham – NPQML application form

The Professional AllianceBirmingham

Application Form for NPQML

General guidance

This form is to be completed by both the Applicant and the Applicant’s Sponsor, usually the head teacher / line manager.

We very much appreciate your time and commitment in completing this application.

The Applicant must complete the registration sections with the personal and contact details (section 1) and the career history details (section 3).

The Sponsor must complete the registration details and the commitment of support section (section 2).

This form is also available in large print, Braille or on audio tape on request.

Equalities Monitoring

A core part of the work of The Professional Alliance Birmingham is to ensure equal opportunity and a good mix of diversity on the programmes. In order to demonstrate this commitment it is necessary for us to collect equalities informationfrom applicants and check levels of representation; to do this we need your assistance. We wouldencourage you, therefore, to complete the separate Equalities Monitoring Guidance Form 2011 – 2012 and return it at the same time asyour application form.

Data will be collated and used to produce anonymised cohort analyses for our steering group and for the National College for School Leadership. The information will be treated as confidential; it will not be matched up with your application form, nor will it be stored in such a way as to identify you as an individual. You will find further information on the form itself.

Data Protection

The information collected on this form and other information which constitutes your participant record will be used incompliance with the Data Protection Act 1998. The information is being collected for the purpose of administering the leadership programmes which The Professional Alliance Birmingham operates under its NationalCollege for School Leadership licence.

The information may be disclosed, as appropriate, to Birmingham City Council in respect of its participation in The Professional Alliance Birmingham, to participating organisations of The Professional Alliance Birmingham, to the National College for School Leadership, and to Law Enforcement Agencies.

I (type name)

  • consent to The Professional Alliance Birmingham recording and processing the information detailed in this application form.
  • understand that this information may be used by The Professional Alliance Birmingham in pursuance of its business purposes and myconsent is conditional upon The Professional Alliance Birmingham complying with their obligations under the Data Protection Act 1998.

Application forms of unsuccessful candidates will be destroyed after six months following commencement of the NPQML programme to which this application relates.

Reference and Commitment of Support

Sponsors are asked to sponsor and support the applicant through the NPQML course. You are asked to provide a simple reference which: -

  • states that, in your professional opinion, the applicant is ready to undertake the NPQML course.
  • commits to supporting the applicant through the NPQML course, providing the necessary funding, where applicable, and the time to undertake relevant development activities.

It is important that sponsors understand the NPQML course and approach to the training. Please view these details at

The deadline for applications is 31 January 2013.

You should note that the application will not be considered without the application form being complete, including the sponsor’s section that comprises of the Reference and Commitment of Support. Late submissions cannot be accepted.

Section 1

Registration: applicant details

Title: / Surname: / First name:
Date of birth: / Phone no: / Mobile no:
Email address: / Teacher ref no:
Present school/organisation:
School/organisation address:
Home address:
My employer will be providing funding for programme fees:
I shall be self-funding programme fees:

Applicant declaration

  • I certify that the information I have provided in this form is correct and my own work.
  • I understand that the NationalCollege may withdraw me from NPQML if I fail to respond to contact from the NationalCollege or The Professional Alliance Birmingham.
  • I will undertake to inform The Professional Alliance Birmingham of any change in my circumstances which may disqualify me from continuing teaching.
  • I certify that I am currently not subject to any disciplinary action and undertake to inform the NationalCollege and The Professional Alliance Birmingham if this status changes in the future.
  • I consent to my employer disclosing such information to the NationalCollege and The Professional Alliance Birmingham as may be necessary to corroborate the personal details provided in this form.
  • I certify that if I am not an applicant from a maintained school, I have up-to-date CRB clearance.You will be asked to produce evidence of this when visiting placement schools and any other schools during the course of the programme.

By submitting this form to The Professional Alliance Birmingham, you are declaring all of the above statements to be true.

Section 2

Registration: sponsor details

Your name:
Your role:
Your place of work
(school/organisation name):
How long have you known the applicant?
Have you agreed to share the Reference and Commitment of Support with the applicant? / yes / no

Sponsor Commitment of Support and Declaration

Can you please provide a short reference that substantiates the applicant’s readiness to embark upon the NPQML programme.In accordance with the Data Protection Act, the applicant you are providing a reference for has the right to view the reference, should they request to do so. Please do not include any information that you would not be happy to discuss with the applicant as part of a professional conversation.

By submitting this form to The Professional Alliance Birmingham, you are declaring the following:

  1. In my professional judgment, the applicant is ready to undertake the NPQML course.
  1. I certify that I know of no legal reason why the applicant should not undertake the NPQML course.
  1. I agree to provide the applicant with the time to undertake the necessary professional development activities associated with the NPQML course.
  1. While the applicant is working towards NPQML status, I undertake to inform his or her NPQML providers/licensees of any relevant change in his or her circumstances which might disqualify him or her from remaining as a leader in school or of any capability issues or disciplinary actions of which he or she is the subject.
  1. I certify that the information I have put on this form is correct.
  1. I have read the NPQML application guidance provided by the NCSL on the DfE website and understood the sections relating to funding contained therein.

As the applicant’s sponsor you will also need to complete the following commitment of support: -

As the applicant’s sponsor, I agree to provide this individual with time to undertake professional development activity in relation to NPQML, should his or her application be successful / yes / no
If no, please give reasons: -
Will the school/organisation be providing funding for the applicant’s programme fees? / yes / no
Is the applicant currently working in a school context? / yes / no

Section 3

Applicant’s Career History

In this section please demonstrate your readiness to undertake the NPQML course by describing your current and previous leadership responsibilities.

Current Leadership Role

Please describe briefly your current leadership roles/responsibilities/work experiences in a school setting. (Word limit – 500 words).

Previous Leadership Role(s)

Please give a brief outline of your previous post(s) and experience as a leader in school during the last five years.

Post held / Dates / Leadership responsibilities

Please submit the completed application formby 31 January 2013 to: -

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The Professional AllianceBirmingham – NPQML application form