Application Form for Selection as an LEA Governor

Before completing this form, please make sure you have read and understood our Policy for Appointing LEA Governors.

Name:

Address:

Town:

County:

Post Code:

Daytime Telephone:

Evening Telephone:

Email:

School for which nomination is preferred:

Are you a parent of a child aged between 5-16 years?

No
Yes

If so, please state which school:

Are you employed in a school?:

No
Yes

If so, please state which school:

Do you have an affiliation to a political party?:

No
Yes

If so, please state which one:

Nominated by:

Nominator Position:

If you are not being nominated by a Political Party, Dudley School or Dudley School Governor please give the name and address of someone who could provide you with a character reference:

Previous service and current governorships:

Relevant experience: (i.e. details of employment, if retired previous employment, voluntary, community or other service):

Reasons for application:

If you are not successfully appointed to the school for which you have been nominated would you be willing to serve at another local school?:

No
Yes

If so, please indicate your preference, if any, for type of school:

Primary
Secondary
Special
Voluntary Aided/Controlled
Foundation

I understand that by submitting this form I am accepting the commitments set out on page 2 of the Policy for Appointing LEA Governors

made @ trilby