Supplementary Panel Application Form 2022/2023

• Published date: 24 November 2021
• Issuer: Department of Education

APPLICATION FORM FOR ACCESS TO THE SUPPLEMENTARY PANEL

FOR THE 2023/24 SCHOOL YEAR

NOTE: Part 1 of this form must be completed in full by applicants for a ll panels.

Part 2 of this form must also be completed by applicants for the Educat e Together or An Foras Pátrúnachta

National Panels.

Part 3 of this form must be signed by all applicants.

Part 4 of this form should be completed by all applicants.

Part 1

1. Panel Details

Name of Panel : _________________________________________________________________

Insert Catholic, Church of Ireland, Educate Together, An Foras Pátrúnachta or ETB.

Panel Area: _________________________________________________________________

(For Catholic or Church of Ireland Diocese Panels insert Name of Dio cese/United Diocese e.g. Catholic Diocese of Cloyne/

United Dioceses of Meath & Kildare. For ETB, insert name of ETB. For Educate Together or An Foras Pátrúnachta, leave blank)

The name of the panel must be the panel area where the majority of teaching service was given in the calendar year 2022

or the panel area where you are currently teaching provided you are contracted (as a minimum) to teach from on or before

16th December 2022 to the end of the 2022/23 school year.

2. Teacher Details

Teacher's Name : _____________________________________ PPSN:_______________________

Teaching Council Registration Number: ____________

(A copy of your Teaching Council Confirmation of Registration must be attached to this form)

Contact Phone No. : ________________________________________

E-Mail Address : ________________________________________

Training College : ________________________________________

3. Irish Language

 Tick this box if you have a particular interest in being redeployed to a school that operates through the medium

of Irish

 Tick this box  if you do not have a particular interest in being redeployed to a school that operates through the

medium of Irish

4. Teaching in a Special School

 Tick this box if you have a particular interest in being redeployed to a special school*

 Tick this box  if you do not have a particular interest in being redeployed to a special school*

(*this relates to special schools which operate under the patronage of your panel o perator; the expression of interest does not

extend to a special class in an ordinary school)