APPLICATION FORM

"Applications for the 2010 Quality Teaching Award are now open.

Closing date: Friday 9 April 2010.

Applicants must also agree to the 2010 Quality Teaching Award Terms and Conditions. A signed copy should be sent to Susan White, NSW Department of Education and Training, Locked Bag 53, DARLINGHURST NSW 2010 by Friday 9 April 2010. "

PERSONAL DETAILS
TITLE:
 FIRST NAME:
 SURNAME:
HOME ADDRESS:
 CITY/SUBURB:
STATE:
 POSTCODE:
HOME PHONE:
 MOBILE PHONE:
PERSONAL EMAIL:
 GENDER:

 

SECTOR INFORMATION
SECTOR:

 

WORKPLACE DETAILS
POSITION:
 SUBJECT / SCHOOL (Uni):
CHILDCARE FACILITY / SCHOOL / COLLEGE (TAFE) / FACULTY OF (Uni):
 INSTITUTION (TAFE / Uni):
WORK ADDRESS:
 CITY/SUBURB:
STATE:
 POSTCODE:
WORK PHONE:
 WORK EMAIL:

 

DEMOGRAPHIC DETAILS
Are you of Aboriginal or Torres Strait Islander Background ?    Yes    No
Are you from a Non English speaking Background ?     Yes    No
Do you have a Disability ?     Yes    No

 

FIRST REFEREE - Education Work Place / Institution Supervisor
FIRST NAME:
 SURNAME:
EMAIL ADDRESS:

 

SECOND REFEREE
FIRST NAME:
 SURNAME:
EMAIL ADDRESS:
 RELATIONSHIP TO APPLICANT:

 

THIRD REFEREE
FIRST NAME:
 SURNAME:
EMAIL ADDRESS:
 RELATIONSHIP TO APPLICANT:

Note: Please ensure that all referee email addresses have been entered correctly as an email will be sent to them containing a link to the referee form they need to complete.

TERMS AND CONDITIONS

Before submitting this electronic form please ensure all provided information is both correct and accurate.

Applicants should read the following documents:
Background and Overview 2010

Learning Portfolio Guidelines 2010

Terms and Conditions 2010

The closing date for nominations is Friday 9 April 2010.

I have read the required documents and agree to be bound by the Terms and Conditions. I have sent a signed copy of the Terms and Conditions to the nominated contact officer.