Common use of Forename Clause in Contracts

Forename. Middle name Last name E-Mail Previous name Surname at birth Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone number Home number Mobile number Personal Details Date of birth NI Number Gender Ethnicity Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service Leaver: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade and when achieved Placements School1 Duration Address School phone number Finance e-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BA, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all of the information I have provided is accurate I confirm I can provide original certificates at the interview stage of my application I understand that the information on this application will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and (insert name of school)

Forename. Middle name Last name E-Mail Previous name Surname at birth Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone name(s) Email Mr Mrs Ms Other NI number Home number Mobile number Personal Details Date of Birth Permanent residential address Or National Client Identifier Mainspring Nominees Limited ref: Previous address (if less than 3 years) (if already a client) Postcode Daytime phone Time at address Years Postcode Mobile phone Nationality For those with dual nationality: Nationality 2 Town of birth NI Number Gender Ethnicity Nationality National Identity National Identity Country of birth Tax residence US Person* UK Yes Other No Please state other countries Gross subscription amount £ . 0 0 This should match the amount you enter in the gross subscription box on page 2. Note: We will not make any investments for you unless we have received the full cleared subscription amount. *US Persons include: 1) individuals who are United States of America (US) citizens (including dual citizens) or resident, US passport holders, green card holders, individuals born in the US who have not renounced their citizenship, permanent residents of the US and those with a ‘substantial presence’ in the US as defined in US tax law; 2) a partnership or corporation organised in the US or under the laws of the US; 3) certain trusts with a US nexus; and 4) a non-US entity which is controlled by US Persons. If you are in any doubt as to whether you are a US Person you should consult an adviser. APPLICATION FORM | 2 Domicile Disability OF 8 REGULATORY REQUIREMENTS To comply with Money Laundering Regulations you must provide an original utility xxxx and an original bank statement, which are less than three months old and which confirm your name and permanent address. The bank statement should be for the account on which your cheque is drawn. These will be returned promptly to you by the Custodian. We are unable to accept Confirmation of Verifcation of Identify forms (Please describeCOVIs) Disabled student allowance Service Leaver: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade Afrom your adviser as an alternate to the above documentation. We may also seek to confirm your identity by using reference agencies to carry out an identity search, which will involve searching sources of information about you. This will not affect your credit rating. If the identity search fails, we may need to ask you for further documents to confirm your identity. HOW HAVE YOU ARRANGED YOUR INVESTMENT? (PLEASE SELECT ONLY ONE OF THE OPTIONS BELOW) I wish to invest directly with Oxford Capital I am investing through an execution-levels/equivalent Subject/grade and when achieved Placements School1 Duration Address School phone number Finance e-mail only broker, but have received no advice in relation to this investment Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BAexecution-only broker, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all of the information I have provided is accurate I confirm I can provide original certificates at the interview stage of my application I understand that the information on this application will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and (insert name of school)if applicable.

Forename. DOB Gender Preferred Surname Preferred Forename Middle name Last name E-Mail Previous name Surname at birth Names Former UPN NCY Actual year Ethnicity and Ethnic Source FSM Eligible Religion Part Time Boarder Medical Flag First Language Connexions Reg Group Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone SEN History SEN Provision SEN Need Exclusions Attendance marks (weekly) Start date End Date Service Family Traveller Family Guardians Enrolment Status Email address lists Data from Children’s Social Care NHS number Home number Mobile number Personal Details Date (Proposed) Appendix B Privacy notices should be placed on the school website for both staff and pupils. We suggest that these privacy notices are also printed and included in induction packs. The text for these notices can be found by visiting the xxx.xxx site here: xxxxx://xxx.xxx.xx/government/publications/data-protection-and-privacy-privacy-notices The LA address you need to add to this document is: xxxx://xxx.xxxxxxxx.xxx.xx/organisation/departments/information-governance/ Information Governance Team Somerset County Council County Hall Taunton TA1 4DY Email: xxxxxxxxxxxxxxxxxxxxx@xxxxxxxx.xxx.xx Appendix C Safe transfer of birth NI Number Gender Ethnicity Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service Leaver: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade sensitive data By Capita B2B and when achieved Placements School1 Duration Address School phone number Finance s2s as outlined in this document By email The SCC e-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do system, which includes the LEAD and EDUC domains uses a secure internal network and associated encryption applications. Any email leaving SCC LEAD or EDUC domain must be regarded as going over untrusted servers Follow all password policy detail correctly When sending sensitive data to unknown email accounts, use the ‘reply to’ function if you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part are sure of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BA, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all identity of the information I have recipient The LA may provide additional secure email systems such as EGRESS, which will be provided is accurate I confirm I can provide original certificates at to secure personal data in transit between the interview stage LA and Schools/Academies. Use of my application I understand that phones and text messages Exercise caution when using mobile phones and text messaging. Phones cannot be encrypted and the information on this application will data may be stored on servers whose security status is unknown to SCC. On no account should personal or sensitive material be sent by text Sending information by post Use window envelopes to display the intended address clearly Limited personal or sensitive data can be sent by post but significant material including Social Care / Health information must be sent using special delivery. Large parcels of personal and sensitive information such as case files should be double wrapped and sent by tracked special delivery or by bonded courier. Include a database return address on the envelope Label the envelopes and made available packets ‘For Addressee only’ Sending information by fax Personal and Sensitive material should not be sent by fax unless absolutely unavoidable, but if this is necessary you should: Ensure that a trusted recipient is waiting at the other end of the fax line Send a preliminary test page to check that the Department fax number is correct On each page use the ‘page X of Y’ function to check that the entire document is sent Check that any fax autocode is correct for Education Signature Date Partnership Agreement confirmation between St Mary’s University the recipient 1 Somerset LA, Somerset School and (insert name of school)Academies 3 xxxx://xxx.xxxxxxxxxxx.xxx.xx/ukpga/2004/31/contents 4 xxxxx://xxx.xxxxxxxxx.xxx.xx/publications/eOrderingDownload/00305-2010DOM-EN-v3.pdf 5 xxxx://xxx.xx.xxx.xx/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107566 6 xxxxx://xxx.xxxxxxxxx.xxx.xx/publications/standard/_arc_Governancemanagementandfinance/Page6/DFES-1916-2005 7 xxxxx://xxx.xxx.xx/media/for-organisations/documents/1065/subject-access-code-of-practice.pdf 8 xxxxx://xxx.xxx.xx/government/publications/the-information-governance-review 9 xxxxx://xxx.xxx.xx/government/uploads/system/uploads/attachment_data/file/535024/data-security-review.PDF 10 xxxx://xxx.xxxxxxxxxxx.xxx.xx/ukpga/2015/28/contents/enacted

Forename. Middle name Last name E-Mail Previous name Surname at birth   Surname/Family Name   Home Address Line1 (not Work address) House No./Name  Town   Street name  County   Address Line 2 Address Line 3 City Country Postcode Phone number Home number Mobile number Personal Details Date of birth 3  Post Code   Payroll Number            Gender Male Female Nationality  NI Number Gender Ethnicity Nationality National Identity National Identity                   DOB (DD/MM/YY)            Email address   Have you been previously employed by The University of Edinburgh? YES NO Are you a current student at the University of Edinburgh? YES NO Ethnic Origin (Please tick the box which describes your ethnic origin) White - British Other Black Mixed - White & Black Caribbean White - Scottish Asian/Asian British Indian Mixed - White & Black African White - Irish Asian/Asian British Pakistani Mixed - White Asian Other White Asian/Asian British Bangladeshi Other Mixed Background Black/Black British Caribbean Chinese Other Ethnic Background Black/Black British African Other Asian Prefer not to disclose Disability I consider myself disabled (please tick relevant box). YES NO If Yes please mark those disabilities relevant to you. Choose up to two options, numbered 1 for main disability and 2 Domicile for any additional disability. General Learning Disability (Please describee.g. Downs syndrome) Disabled student allowance Service Leaver: YesA social/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade Acommunication impairment (e.g. Asperger’s/other autistic spectrum disorder) Long-levelsStanding Illness/equivalent Subject/grade and when achieved Placements School1 Duration Address School phone number Finance eCondition (e.g. Cancer, HIV, Diabetes, Chronic Heart Disease or Epilepsy) Mental Health Condition (e.g. depression, schizophrenia) Specific Learning Difficulty (e.g. dyslexia, dyspraxia) Deaf or serious hearing impairment Blind or serious visual impairment Prefer not to disclose this information Bank Mandate (failure to complete this section may result in late or non-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BApayment) Bank Name  Sort Code     ▬     ▬     Bank Address    Account Number                 By signing this document, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all of the information I have provided is accurate I confirm I can provide original certificates at have the interview stage of my application right to carry out the work in question, and will demonstrate this to the University prior to commencing this work (see appendix 1 and 2). Date    /     /     Signature   Please find P45 attached to this form OR I understand that have completed the P46 form overleaf Instructions for employees As a new employee your employer needs the information on this application form before your first payday to tell HMRC about you and help them use the correct tax code. Fill in this form then give it to your employer. Do not send this form to HMRC. Employee’s personal details Last name or family name  First name(s)  Are you male or female? Male Female Date of birth eg dd mm yyyy                Home address Address line 1  Address line 2  Address line 3  Address line 4  Postcode (if your address is in the UK)  National Insurance number                  Employee statement You need to tick only one of the statements A, B or C. A – This is my first job since last 6 April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State Pension or Occupational Pension. B – This is now my only job but since last 6 April I have had another job, or received taxable Jobseeker’s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State Pension or Occupational Pension. C – As well as my new job, I have another job or receive a State Pension or Occupational Pension. Have you left a course of UK higher education before last 6 April and received your first UK Student Loan instalment on or after 1 September 1998 and not fully repaid your Student Loan? Yes No Are you repaying your UK Student Loan by agreement with the UK Student Loans Company to make monthly payments through your bank or building society account? Yes No Job Details – To be completed by UoE (Administration) Job Title  SOC Code (See Appendix 3)   Grade  Department   Nature of Work  Period of Engagement (dd/mm/yy) From:            To:             Total Hours  Hourly Rate   Holiday % (12.07%)   Total Paid (inc. Holiday Allow) £  Costing Details – Source of Funds % or Amount in £ Account Cost Centre Job Code                                                                                                       Management Authorisation – To be completed by UoE (HoS / DoPS / Director of Department) I confirm the Job Details noted above is correct and shall be applied for this payment. I confirm verified copy(s) of documentary evidence of right to work in the UK has been identified and attached to this form, with a copy retained for our reference. (as per Appendix 2 List A and List B) Name  Position   Date            Signature   Right to Work Authorisation – Enter details of person who performed Right to Work checks Name  Department  Contact Telephone Number  Note: Please complete this form in full. Any forms which do not have the right to work checklist completed will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and returned, which may delay any payment due. HR Authorisation – To be Completed by UoE (insert name of schoolCollege HR / Support Groups HR).  

Forename. Middle House no. / name Last & Street Agent Liberty Living Limited City Residence name ELiberty Point County Postcode Residence address Xxxxxx Xxxxxx, Xxxxxxxxxx, XX0 0XX Please tick the appropriate box I am a student as defined under Part B: Terms & Conditions 7. Definition of a student University Course I am not a student as defined under Part B: Terms & Conditions 7. Definition of a student In this Agreement, You agree to: (i) the terms set out in the Booking Form in Part A; (ii) the general Terms in Part B; and (iii) the Licence in Part C, (together, the “Agreement”). Signed Date For Liberty Living use only Counter-Mail Previous name Surname at birth Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone number Home number Mobile number Personal Details signed by Liberty Living Date: Total fee payable (total cost of stay, including the advance rent booking fee) Includes bedding pack* Booking fee (pay now) (1 week’s rent). Advance payment against the Licence fee (non-refundable), Licence fee (pay later) (minus advance rent booking fee) Due date D D / M M / Y Y Y Y Date of birth NI Number D D / M M / Y Y Y Y Gender Ethnicity Male Female Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service LeaverTelephone number Including international dialling code: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade and when achieved Placements School1 Duration Address School phone Email address Contact name Relation to you Telephone number Finance e-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position Including international dialling code: Which University do you currently holdattend? Full time/ Reason for your visit? Are you returning to Liberty Living? Yes No If yes, name current residence Which course are you studying? Fees Accommodation details Room type Building Rental period (Licence Period) Agreed move in date D D / M M / Y Y Y Y Agreed move out date D D / M M / Y Y Y Y Personal information Emergency contact details 12th January 2016 5th April 2016 Summer bookings Part time A: Booking form * The licence fee payable is for ‘room only’ unless otherwise stated. If part time percentage of time working as you require a teacher Is the school bedding pack (pillow, pillow case, sheet, duvet and duvet cover) and/or a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ kitchen pack, visit our recommended supplier UniKitOut for prices and availability at: xxx.xxxxxxxxx.xxx/xxxxxxxxxxx/xxxxxxx. Summer bookings Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalentB: BA, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all of the information I have provided is accurate I confirm I can provide original certificates at the interview stage of my application I understand that the information on this application will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and (insert name of school)Terms & Conditions

Forename. Middle Position Nationality DIRECTOR 2 Title Surname (as in passport) Forename Position Nationality DIRECTOR 3 Title Surname (as in passport) Forename Position Nationality Additional details which are important DIRECTORS / AUTHORISED SIGNATORIES Specimen Signature 1 Specimen Signature 2 Specimen Signature 3 INDIVIDUAL INVESTOR APPLICATION INVESTOR 1 Please complete in block letters Existing Client Yes No Title Mr Mrs Miss Other (please state) Male Female Full name Last name E-Mail Previous name Surname at birth Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone number Home number Mobile number Personal Details (as in passport) Date of birth NI Number Gender Ethnicity X X X X X X X X Xxxxxxx Xxxxxx: Single Married Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service Leaver: YesPassport/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade and when achieved Placements School1 Duration ID number Residential Address School phone number Finance e-mail P.O. Box if applicable Country of residence Telephone Office Residence Mobile Fax Email Profession Employer / Name of Head Teacher business Designation Office Address Please send my communication/confirmations/regular correspondence by Postal Mail Email Address for correspondence (if different from above) Emirate / State Additional details which are important Mode of operation Single Joint Other (please state) INVESTOR 2 Relationship to Investor 1 Existing Client Yes No Title Mr Mrs Miss Other Male Female Full name (as in passport) Date of birth X X X X X X X X Xxxxxxx Xxxxxx: Single Married Nationality Passport/ID number Residential Address P.O. Box required - if different from Investor 1 Country of residence Telephone Office Residence Mobile Fax Email Profession Employer/Name of school CPD co- ordinatorbusiness Designation Office Address SECTION 2 INVESTMENT DETAILS Please state the total amount you wish to invest: Total investment amount Currency Amount in words Funding Mode aDcecboiut nEtmirates NBD/Professional Tutor What position do you currently hold? Full time/ Part time If part time percentage EIB Account number Cheque (only local currency accepted) TT In case of time working refunds/dividends/interest payments, please credit my Emirates NBD/EIB account number or by manager cheque / TT as a teacher Is per the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has below details Account number Please invest for me/us in the school previously worked with St Mary’s? Is funds/investment products indicated below which can be purchased for the school part remittance amount stated below: Name of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BAFund/Product Investment Amount Currency By completing and signing this application form, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I I/we confirm that I/we have read and understood the term sheet, prospectus and supplement (where applicable) for the investment products applied for. • Term sheet(s) for investment(s) attached, signed and dated Yes SECTION 3 SOURCE OF FUNDS MANDATORY INFORMATION REQUIRED FOR ACCEPTANCE UNDER MONEY LAUNDERING GUIDELINES The Business Introducer should complete the following section with all of investors: Failure to complete this section may cause delay in processing the information I have provided is accurate I confirm I can provide original certificates at Application. Relationship to Investor 1 1 Have the interview stage of my application I understand that funds for the information on this application will be stored on a database and made available to the Department for Education Signature Date Partnership Agreement confirmation between St Mary’s University and (insert name of school)investment been raised from:

Forename. DOB Gender Preferred Surname Preferred Forename Middle name Last name E-Mail Previous name Surname at birth Names Former UPN NCY Actual year Ethnicity and Ethnic Source FSM Eligible Religion Part Time Boarder Medical Flag First Language Connexions Reg Group Address Line1 Address Line 2 Address Line 3 City Country Postcode Phone SEN History SEN Provision SEN Need Exclusions Attendance marks (weekly) Start date End Date Service Family Traveller Family Guardians Enrolment Status Email address lists Data from Children’s Social Care NHS number Home number Mobile number Personal Details Date (Proposed) Appendix B Privacy notices should be placed on the school website for both staff and pupils. We suggest that these privacy notices are also printed and included in induction packs. The text for these notices can be found by visiting the xxx.xxx site here: xxxxx://xxx.xxx.xx/government/publications/data-protection-and-privacy-privacy-notices The LA address you need to add to this document is: xxxx://xxx.xxxxxxxx.xxx.xx/organisation/departments/information-governance/ Information Governance Team Somerset County Council County Hall Taunton TA1 4DY Email: xxxxxxxxxxxxxxxxxxxxx@xxxxxxxx.xxx.xx Appendix C Safe transfer of birth NI Number Gender Ethnicity Nationality National Identity National Identity 2 Domicile Disability (Please describe) Disabled student allowance Service Leaver: Yes/No Entry Qualification details Maths GCSE grade English GCSE grade Science GCSE grade A-levels/equivalent Subject/grade sensitive data By Capita B2B and when achieved Placements School1 Duration Address School phone number Finance s2s as outlined in this document By email The SCC e-mail Name of Head Teacher Name of school CPD co- ordinator/Professional Tutor What position do system, which includes the LEAD and EDUC domains uses a secure internal network and associated encryption applications. Any email leaving SCC LEAD or EDUC domain must be regarded as going over untrusted servers Follow all password policy detail correctly When sending sensitive data to unknown email accounts, use the ‘reply to’ function if you currently hold? Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught School experience of QTS assessment Has the school previously worked with St Mary’s? Is the school part are sure of the St Mary’s school partnership? Has the school had experience of QTS candidates through another provider? Mentor experience of ITE Please give details of mentor’s experience Has the mentor undertaken any mentor training? If yes through which institution School 2 Placement 2 duration Address Position held Full time/ Part time If part time percentage of time working as a teacher Is the school a State primary Academy International State secondary Free School COBIS Special school Independent Other Age range of pupils taught Subjects taught Course Phase ITT subject 1 ITT subject 2 ITT subject 3 Entry Details Additional Academic Qualifications First degree or equivalent: BA, BSc, other Subject of UG degree Class of UG degree Awarding Institution Date undergrad degree obtained Date skills tests passed English Math DBS Certificate number Applicant statement I confirm that all identity of the information I have recipient The LA may provide additional secure email systems such as EGRESS, which will be provided is accurate I confirm I can provide original certificates at to secure personal data in transit between the interview stage LA and Schools/Academies. Use of my application I understand that phones and text messages Exercise caution when using mobile phones and text messaging. Phones cannot be encrypted and the information on this application will data may be stored on servers whose security status is unknown to SCC. On no account should personal or sensitive material be sent by text Sending information by post Use window envelopes to display the intended address clearly Limited personal or sensitive data can be sent by post but significant material including Social Care / Health information must be sent using special delivery. Large parcels of personal and sensitive information such as case files should be double wrapped and sent by tracked special delivery or by bonded courier. Include a database return address on the envelope Label the envelopes and made available packets ‘For Addressee only’ Sending information by fax Personal and Sensitive material should not be sent by fax unless absolutely unavoidable, but if this is necessary you should: Ensure that a trusted recipient is waiting at the other end of the fax line Send a preliminary test page to check that the Department fax number is correct On each page use the ‘page X of Y’ function to check that the entire document is sent Check that any fax autocode is correct for Education Signature Date Partnership Agreement confirmation between St Mary’s University the recipient 1 Somerset LA, Somerset School and (insert name of school)Academies 3 xxxx://xxx.xxxxxxxxxxx.xxx.xx/ukpga/2004/31/contents 4 xxxxx://xxx.xxxxxxxxx.xxx.xx/publications/eOrderingDownload/00305-2010DOM-EN-v3.pdf 5 xxxx://xxx.xx.xxx.xx/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_107566 6 xxxxx://xxx.xxxxxxxxx.xxx.xx/publications/standard/_arc_Governancemanagementandfinance/Page6/DFES-1916-2005 7xxxx://xxx.xxx.xxx.xx/~/media/documents/library/Data_Protection/Detailed_specialist_guides/data_sharing_code_of_practice.pdf 8 xxxxx://xxx.xxx.xx/government/publications/the-information-governance-review