SENCO Teacher Programme

Application for Study – National Award for SEN Coordination

Additional Information form

This form needs to be completed fully and then uploaded with your SENCO application via the online portal.

Surname:
Forename:
Date of Birth:
School Address:
Postcode:
School Telephone:
School e-mail:
Name of Head Teacher (see note below):
Name of Local Authority (Code):
Derbyshire (DB) Derby City (DC) Leicestershire (LS) Leicester City (LC) Lincolnshire (L) Northamptonshire (N) Nottingham City (NC) Rutland (R) Milton Keynes (MK) Warwickshire (W)
Qualified Teacher Status
I am a Teacher and have English Qualified Teacher Status (QTS) Yes / No
7 digit teacher’s reference number
(if you do not know your reference number, please contact
Teachers Pensions on 08456 066166) / Teacher Ref No:
I have completed my induction year / Yes / No
Number of Years Teaching / Date:
Date of first appointment to SENCO in your current school
Date of appointment to first SENCO role (if different from the above) / Date:
Date:
School URN (Unique Reference Number) – TDA is now requesting this 6 digit no. / School URN:

To enable you to enrol on this course you will require your Head Teacher’s recommendation, please ensure that you provide their contact details on the application form and pass the Head Teacher Recommendation form to them for their completion.

Declaration

I certify that to the best of my knowledge the information contained in this application form is correct and complete and if registered for this course I agree to abide by the rules and regulations of the University of Northampton as amended from time to time and to observe the Code of Conduct (see

I understand that an electronic record will be created using the supplied information and give permission for staff of the University of Northampton, Local Authority, and the TA to access any information held in connection with the course.

Please note that the applications will be discussed with your Local Authority who will make the decision with regards to your application.

I have read and agree to the declaration above.

Print Name: Date:

Sign:

Should you have any questions please contact Team 2by telephone on 03003032772 or by email to .

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2010-11/JT037