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International Community for Professional Learning Conversations (IC4PLC)
Application instructions
1. Download and complete the form
2. Return the form electronically as an attached WORD doc to either: Tom Whittingham: [email protected] (if you are an English based
Headteacher); or Warren Marks: [email protected] (if you are an Australian-
based Principal)
3. Retain a full copy of your application.
Form Contents:
Section 1: Personal Photo (Page 1)
Section 2: Personal Profile (Page 2)
Section 3: School Profile (Page 3)
SECTION 1: PERSONAL PHOTO
Please insert portrait photo
Page 1
SECTION 2: PERSONAL PROFILE
Name ___________________________________________
Age ________
Gender _____________
Personal phone contact _____________________________________________________________
Best email address __________________________________________________________________
Professional history
(Please include any relevant research and leadership enquiry work undertaken, awards,years in the Headship/Principalship, phases taught, Headteacher/ principal association involvement; qualifications & other relevant professional experiences etc.)
Professional areas of interest that you would like to develop: eg building leadership capacity in my organization, becoming a self-regulating learning community
Personal hobbies and interests:
Page 2
SECTION 3: SCHOOL PROFILE
School/Work Place: _________________________________________________________________
School/Work Place address: __________________________________________________________
____________________________________________________________
______________________________________________________________
Work Contact details:
Mobile-_____________________________________________________________________
Phone-_____________________________________________________________________
Email-______________________________________________________________________
School description:Please include specific school information (e.g. classification; enrolment numbers; special programs and foci for school improvement, staff development; geographic location; special education units; student and staff profiles).
Page 3
SECTION 4: PROGRAM COORDINATORS
England
Tom WhittinghamHead of External Development (Institute of Education)University of WorcesterPhone: 01249 723706Mobiles: 07788 301509 ; 07801 428137E-mail: [email protected]: http://www.worcester.ac.uk/discover/leadership-development.html
Australia
Sue Lazenby and Dr Warren Marks
Directors LEAP (Leading Educators Around the Planet)
Phone: +61 2 4889 8696
Mobiles: +61 412 049 637; +61 412 960 108
E-mail: [email protected] or [email protected]
Website: www.aleap4principals.com.au
Dr Norman McCulla
Coordinator Educational Leadership Programs
Macquarie University
Email: [email protected]
Phone: +62 2 9850 8650
Page 4