Title
Mr Ms Miss Mrs

First name

Last name

Date of birth

Address

Postcode

Telephone number (home)

Telephone number (work)

Email address

School

Type of governor

Current CRB check

Please tick this box if you believe you have had a CRB check, carried out by Salford City Council, within the last three years

Declarations

I agree to my contact details (email address, postal address and telephone numbers) being made available to other officers of Salford City Council

I declare that I am not disqualified from serving as a school governor under the School Governance (Constitution) (England) Regulations 2003 and I certify that I have read and considered the criteria for eligibility of governors set out above and confirm that I am not disqualified from becoming a governor. I agree to inform the Clerk of the Governing Body, in writing, immediately should I cease to be eligible to serve as a governor (required)