Excellent Teacher – Application for assessment (Wales)
Data Protection Act 1998:
The DCSF may process the information collected in this document for the purpose of assessing
and monitoring teachers’ applications to become Excellent Teachers. This information will be processed only within the terms of the Department’s Data Protection notification.
The applicant and the headteacher should read the Excellent Teacher guidance before completing this form. In particular, the applicant should check that they meet all of the
The Excellent Teacher Scheme applies in schools and in all other settings where teachers are
employed under the School Teachers’ Pay and Conditions Document. In this document the term ’school’ should be taken as including all such settings. Teachers not working in schools should substitute ‘service manager’ or ‘line manager’ wherever ‘headteacher’ is used.
If you are completing this form electronically, please note that any text which disappears below the bottom of the cell will not print out. If you completing it by hand, please use black ink.
Part 1: TEACHER DETAILS
Title: Mr Mrs Miss Ms Other
Sex: Male Female
Do you currently hold qualified teacher status (QTS)? Yes No
DCSF or Welsh Office teacher reference number (7 digits)
If you are unsure of your teacher reference number contact ‘Teachers' Pensions’ on 08456 066166
Preferred telephone contact number Preferred email contact address
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Are you an accredited representative of a recognised trade union? Yes No
Do you have a long term mental or physical impairment that has a substantial Yes No adverse effect on your ability to carry out the day-to-day activities of your job?
Present position/job title
What was the effective date from which you were first appointed to point 3 of the pay scale for post-threshold teachers?
Please enter your main teaching subject in the box below using a subject description from Annex 1. This information will be used to ensure that the assessor allocated to carry out your assessment has
the same area of expertise as you. Do not leave this box blank.
Main teaching subject
If ‘other’ please specify
Current school details
Name of school
School address (inc postcode)
Telephone number Fax number
Name of headteacher
Name of local authority
Local authority number (three digits)
Unique Reference Number (URN) (6 digits)
(Check EduBase if you are unsure of your school’s URN)
Phase of school/type of service
Primary Secondary Special PRU Nursery
Mid deemed primary Mid deemed secondary Other (specify)
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In this section you will need to show that you have continued to develop yourself professionally and provided regular coaching and mentoring to others. You will also need to provide a specific example of searching analysis that you have carried out, normally within the last 2 years. In doing this, you should explain how you addressed the identified needs of a group or groups of pupils, and
show that it was of sufficient substance to have had a positive impact beyond your assigned pupils. In each case you will also need to describe the evidence of the impact of the activity/work.
Please describe how you have continued to develop yourself professionally
What is the evidence of the impact of these activities?
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Please describe your role in coaching and mentoring others
What is the evidence of the impact of this activity/work?
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Please provide an example of a piece of work (normally undertaken within the last 2
years) that: involved searching analysis/research, identified and addressed the needs of
a particular group of pupils and was of sufficient substance to have an impact beyond
your own pupils
What is the evidence of the impact of this work?
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Part 2: EXCELLENT TEACHER STANDARDS
All those wishing to become Excellent Teachers will need to meet the standards specified in Annex 2.
Please provide succinct examples, from the last 2 years, of your achievements and expertise in relation to the standards. You can, if you wish, further utilise elements of the examples you provided in Part 1 of this form, if you feel that it is appropriate. You are not required to produce separate examples for each standard, although nothing prevents you from doing so. Similarly, you may use the same example more than once if you feel it is appropriate. It is important,
however, that the evidence you provide must, when taken as a whole, show that you meet all the
Excellent Teacher standards.
Once you have completed the relevant parts of the form, you will need to pass it to your headteacher.
Once the applicant has completed the form, please:
ensure that the declaration is signed and dated, by the applicant
add your comments in all the relevant places
retain copies for yourself and the applicant
sign the completed form and send it to the national assessment agency at:
National Assessment Agency for ASTs and ETs
VT Education and Skills
Bay Tree Avenue
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1. PROFESSIONAL ATTRIBUTES
Please provide evidence relating to the following standards: E1 and E2
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PROFESSIONAL KNOWLEDGE AND UNDERSTANDING Please provide evidence relating to the following standards: E3, E4, E5 and E6
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PROFESSIONAL SKILLS: Planning
Please provide evidence relating to the following standard: E7
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PROFESSIONAL SKILLS: Teaching
Please provide evidence relating to the following standards: E8 and E9
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