Form: PPQA-01 · 5 Form: PPQA-01 Revised September 2018 * LANGUAGE SUBJECTS - RESIDENTIAL...
17
Revised 1 January 2021 Form: PPQA-01 Application for Registration and the Assessment of Qualifications In accordance with the Teaching Council (Registration) Regulations 2016: Route 2 (Post-Primary) Important: Please read the notes below and Guidance Notes before submitting your application 1. Evidence of recognition under EU Directive 2005/36/EU Your application cannot be processed without evidence that you are a fully qualified post-primary teacher in the country in which you completed your initial teacher education qualification and that you have completed any period of statutory post-qualification induction/probation. This evidence can be obtained from the competent authority in that country (e.g. Teaching Council equivalent body/ Department/Ministry of Education). If completed in an EU/EEA member state, your statement must confirm you are recognised under the EU Directive 2005/36/EC. 2. Required Documentation Please ensure that you submit all required documentation including evidence of all your teaching experience and academic study to date. Please use the checklist provided. 3. Processing Time An assessment of your application and qualifications can only commence when you have submitted all required documentation to the Council. It does not start from the date you submit your first application. It is only when all documents have been received that an assessment of your file is can commence. It is your responsibility to ensure that all requested documentation has been submitted. The assessment will take approximately twelve weeks from the date of receipt of all requested documentation. 4. Curricular Subject Requirement In order to register under Route 2 Post-primary, you must meet the requirements for at least one post-primary curricular subject. You must consult the Council's Post-primary Curricular Subject Requirements before determining which subject(s) to apply for. Click here to read the requirements.
Transcript of Form: PPQA-01 · 5 Form: PPQA-01 Revised September 2018 * LANGUAGE SUBJECTS - RESIDENTIAL...
Revised 1 January 2021
Form PPQA-01Application for Registration and the Assessment of Qualifications In accordance with the Teaching Council (Registration) Regulations 2016 Route 2 (Post-Primary)
Important Please read the notes below and Guidance Notes before submitting your application
1 Evidence of recognition under EU Directive 200536EU
Yourapplicationcannotbeprocessedwithoutevidencethatyouareafullyqualifiedpost-primaryteacherinthecountryinwhichyoucompletedyourinitialteachereducationqualificationandthatyouhavecompletedanyperiodofstatutorypost-qualificationinductionprobationThisevidencecan be obtained from the competent authority in that country (eg Teaching Council equivalent body DepartmentMinistry of Education) If completed in an EUEEA member state your statement mustconfirmyouarerecognisedundertheEUDirective200536EC
2 Required Documentation
Please ensure that you submit all required documentation including evidence of all your teaching experience and academic study to date Please use the checklist provided
3 Processing Time
Anassessmentofyourapplicationandqualificationscanonlycommencewhenyouhavesubmitted all required documentation to the Council It does not start from the date you submit yourfirstapplicationItisonlywhenalldocumentshavebeenreceivedthatanassessmentofyourfileiscancommenceItisyourresponsibilitytoensurethatallrequesteddocumentationhasbeensubmitted The assessment will take approximately twelve weeks from the date of receipt of all requested documentation
4 Curricular Subject Requirement
In order to register under Route 2 Post-primary you must meet the requirements for at least one post-primary curricular subject You must consult the Councils Post-primary Curricular Subject Requirements before determining which subject(s) to apply for Click here to read the requirements
2
Form PPQA-01
Revised 1 January 2021
SECTION A ndash Personal Details
PPS No
Teaching Council Registration Number
Title
Surname
Forename
Gender Male Female Other
Date of Birth
Nationality
Previous Name
Address for Correspondance
Eircode
Mobile phone No
Home phone No
D D M M Y Y Y Y
Re co rd e d fo r stat i st i c a l p u r p o s e s
P re f i x
P re f i x
e g ( B i r t h n a m e o r c h a n ge o f n a m e b y b y d e e d p o l l
This must be a residential address Notices served under Section 62 of the Teaching Council Act 2001 will be served to this address
3
Form PPQA-01
Revised 1 January 2021
SECTION B ndash Authorisation for the Transfer of QualificationsRegistration Details to Paymaster for current or prospective employers
I
herebyauthorisetheTeachingCounciltoprovidedetailsrelatingtomyQualificationstomypaymaster(ie The Department of Education amp Skills or ETB) Yes No
Authorisation for Transfer of Details from Employer to Teaching Council
In some cases in order to complete the registration process the Teaching Council may be required toseekfurtherinformationregardinganapplicantrsquosqualificationsorinrelationtothequalificationallowances that an applicant has been granted by hisher employer
I
Education and Skills or ETB to transfer to the Teaching Council details relating to the status of my qualificationsprobationaryperiodorthequalificationallowancesthatIhaveattained Yes No
I N S E RT YO U R N A M E H E R E
I N S E RT YO U R N A M E H E R E
4
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Assessment of Academic Subjects In order to register with the Teaching Council under Route 2 (Post-primary) you must meet the requirements for at least one post-primary curricular subject Before making an application you should familiarise yourself with the specificcurricularsubjectrequirements for your chosen subject(s) The requirements are available for download at wwwteachingcouncilie Please select at least one subject from the list below (insert tick mark )
Accounting
Agricultural Economics
Agricultural Science
Applied Mathematics
Art(includingCrafts)
Biology
Business
Chemistry
CSPE (Civic Social and Political Education)
Classical Studies
Information and Communications Technology (ICT)
Computer Science
Construction Studies
Economics
Engineering
English
French
Geography
German
Greek (Ancient Greek)
Hebrew Studies
History
Home Economics (ScientificandSocial)
Italian
Japanese
Arabic
Gaeilge Irish
Latin
Mathematics
Music
Physical Education
Physics
Physics and Chemistry
Politics amp Society
Religious Education
Russian
Spanish
Design and Communication Graphics (formerly Technical Drawing)
Technology
Please indicate the qualifications you wish to have assessed in this application (insert tick mark )
1 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Undergraduate Qualification
Other Relevant Qualification
Teacher EducationConcurrent1Qualification
5
Form PPQA-01
Revised 1 January 2021
LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including GaeilgeIrish Please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
Please tick as appropriate
1 My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages) is listed on my enclosedqualificationtranscripts
or2 I enclose with this application evidence of both my residential experience
and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages)
CEFR
CEFR
Residency
Residency
SECTION C ndash Qualifications Assessment
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
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- Check Box 1 Off
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2
Form PPQA-01
Revised 1 January 2021
SECTION A ndash Personal Details
PPS No
Teaching Council Registration Number
Title
Surname
Forename
Gender Male Female Other
Date of Birth
Nationality
Previous Name
Address for Correspondance
Eircode
Mobile phone No
Home phone No
D D M M Y Y Y Y
Re co rd e d fo r stat i st i c a l p u r p o s e s
P re f i x
P re f i x
e g ( B i r t h n a m e o r c h a n ge o f n a m e b y b y d e e d p o l l
This must be a residential address Notices served under Section 62 of the Teaching Council Act 2001 will be served to this address
3
Form PPQA-01
Revised 1 January 2021
SECTION B ndash Authorisation for the Transfer of QualificationsRegistration Details to Paymaster for current or prospective employers
I
herebyauthorisetheTeachingCounciltoprovidedetailsrelatingtomyQualificationstomypaymaster(ie The Department of Education amp Skills or ETB) Yes No
Authorisation for Transfer of Details from Employer to Teaching Council
In some cases in order to complete the registration process the Teaching Council may be required toseekfurtherinformationregardinganapplicantrsquosqualificationsorinrelationtothequalificationallowances that an applicant has been granted by hisher employer
I
Education and Skills or ETB to transfer to the Teaching Council details relating to the status of my qualificationsprobationaryperiodorthequalificationallowancesthatIhaveattained Yes No
I N S E RT YO U R N A M E H E R E
I N S E RT YO U R N A M E H E R E
4
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Assessment of Academic Subjects In order to register with the Teaching Council under Route 2 (Post-primary) you must meet the requirements for at least one post-primary curricular subject Before making an application you should familiarise yourself with the specificcurricularsubjectrequirements for your chosen subject(s) The requirements are available for download at wwwteachingcouncilie Please select at least one subject from the list below (insert tick mark )
Accounting
Agricultural Economics
Agricultural Science
Applied Mathematics
Art(includingCrafts)
Biology
Business
Chemistry
CSPE (Civic Social and Political Education)
Classical Studies
Information and Communications Technology (ICT)
Computer Science
Construction Studies
Economics
Engineering
English
French
Geography
German
Greek (Ancient Greek)
Hebrew Studies
History
Home Economics (ScientificandSocial)
Italian
Japanese
Arabic
Gaeilge Irish
Latin
Mathematics
Music
Physical Education
Physics
Physics and Chemistry
Politics amp Society
Religious Education
Russian
Spanish
Design and Communication Graphics (formerly Technical Drawing)
Technology
Please indicate the qualifications you wish to have assessed in this application (insert tick mark )
1 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Undergraduate Qualification
Other Relevant Qualification
Teacher EducationConcurrent1Qualification
5
Form PPQA-01
Revised 1 January 2021
LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including GaeilgeIrish Please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
Please tick as appropriate
1 My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages) is listed on my enclosedqualificationtranscripts
or2 I enclose with this application evidence of both my residential experience
and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages)
CEFR
CEFR
Residency
Residency
SECTION C ndash Qualifications Assessment
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
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- Check Box 1 Off
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- Text Field 93
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- Check Box 69 Off
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- Check Box 100 Off
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- Check Box 85 Off
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- Text Field 110
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3
Form PPQA-01
Revised 1 January 2021
SECTION B ndash Authorisation for the Transfer of QualificationsRegistration Details to Paymaster for current or prospective employers
I
herebyauthorisetheTeachingCounciltoprovidedetailsrelatingtomyQualificationstomypaymaster(ie The Department of Education amp Skills or ETB) Yes No
Authorisation for Transfer of Details from Employer to Teaching Council
In some cases in order to complete the registration process the Teaching Council may be required toseekfurtherinformationregardinganapplicantrsquosqualificationsorinrelationtothequalificationallowances that an applicant has been granted by hisher employer
I
Education and Skills or ETB to transfer to the Teaching Council details relating to the status of my qualificationsprobationaryperiodorthequalificationallowancesthatIhaveattained Yes No
I N S E RT YO U R N A M E H E R E
I N S E RT YO U R N A M E H E R E
4
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Assessment of Academic Subjects In order to register with the Teaching Council under Route 2 (Post-primary) you must meet the requirements for at least one post-primary curricular subject Before making an application you should familiarise yourself with the specificcurricularsubjectrequirements for your chosen subject(s) The requirements are available for download at wwwteachingcouncilie Please select at least one subject from the list below (insert tick mark )
Accounting
Agricultural Economics
Agricultural Science
Applied Mathematics
Art(includingCrafts)
Biology
Business
Chemistry
CSPE (Civic Social and Political Education)
Classical Studies
Information and Communications Technology (ICT)
Computer Science
Construction Studies
Economics
Engineering
English
French
Geography
German
Greek (Ancient Greek)
Hebrew Studies
History
Home Economics (ScientificandSocial)
Italian
Japanese
Arabic
Gaeilge Irish
Latin
Mathematics
Music
Physical Education
Physics
Physics and Chemistry
Politics amp Society
Religious Education
Russian
Spanish
Design and Communication Graphics (formerly Technical Drawing)
Technology
Please indicate the qualifications you wish to have assessed in this application (insert tick mark )
1 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Undergraduate Qualification
Other Relevant Qualification
Teacher EducationConcurrent1Qualification
5
Form PPQA-01
Revised 1 January 2021
LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including GaeilgeIrish Please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
Please tick as appropriate
1 My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages) is listed on my enclosedqualificationtranscripts
or2 I enclose with this application evidence of both my residential experience
and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages)
CEFR
CEFR
Residency
Residency
SECTION C ndash Qualifications Assessment
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
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- Text Field 5
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- Text Field 15
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- Text Field 24
- Text Field 25
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- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
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- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
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- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
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- Check Box 49 Off
- Check Box 25 Off
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- Check Box 27 Off
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- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
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- Text Field 38
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- Text Field 51
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- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
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- Text Field 62
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- Text Field 59
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- Text Field 64
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- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
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- Text Field 80
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- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
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- Text Field 1027
- Text Field 1013
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- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
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- Text Field 1022
- Text Field 1011
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- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
4
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Assessment of Academic Subjects In order to register with the Teaching Council under Route 2 (Post-primary) you must meet the requirements for at least one post-primary curricular subject Before making an application you should familiarise yourself with the specificcurricularsubjectrequirements for your chosen subject(s) The requirements are available for download at wwwteachingcouncilie Please select at least one subject from the list below (insert tick mark )
Accounting
Agricultural Economics
Agricultural Science
Applied Mathematics
Art(includingCrafts)
Biology
Business
Chemistry
CSPE (Civic Social and Political Education)
Classical Studies
Information and Communications Technology (ICT)
Computer Science
Construction Studies
Economics
Engineering
English
French
Geography
German
Greek (Ancient Greek)
Hebrew Studies
History
Home Economics (ScientificandSocial)
Italian
Japanese
Arabic
Gaeilge Irish
Latin
Mathematics
Music
Physical Education
Physics
Physics and Chemistry
Politics amp Society
Religious Education
Russian
Spanish
Design and Communication Graphics (formerly Technical Drawing)
Technology
Please indicate the qualifications you wish to have assessed in this application (insert tick mark )
1 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Undergraduate Qualification
Other Relevant Qualification
Teacher EducationConcurrent1Qualification
5
Form PPQA-01
Revised 1 January 2021
LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including GaeilgeIrish Please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
Please tick as appropriate
1 My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages) is listed on my enclosedqualificationtranscripts
or2 I enclose with this application evidence of both my residential experience
and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages)
CEFR
CEFR
Residency
Residency
SECTION C ndash Qualifications Assessment
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
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- Check Box 1 Off
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- Text Field 35
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- Check Box 54 Off
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- Check Box 56 Off
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- Check Box 59 Off
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- Check Box 69 Off
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- Check Box 85 Off
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- Text Field 110
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5
Form PPQA-01
Revised 1 January 2021
LANGUAGE SUBJECTS - RESIDENTIAL EXPERIENCE AND LINGUISTIC COMPETENCEThis section applies to those applying for language subjects only including GaeilgeIrish Please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
Please tick as appropriate
1 My residential experience and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages) is listed on my enclosedqualificationtranscripts
or2 I enclose with this application evidence of both my residential experience
and Linguistic Competence (minimum B2 on the Common European Framework of Reference for Languages)
CEFR
CEFR
Residency
Residency
SECTION C ndash Qualifications Assessment
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
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- Text Field 3
- Text Field 11
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- Check Box 1 Off
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- Text Field 33
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- Check Box 4 Off
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- Text Field 35
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- Check Box 54 Off
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- Check Box 56 Off
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- Check Box 59 Off
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- Check Box 69 Off
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- Check Box 100 Off
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- Text Field 102
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- Text Field 1028
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- Check Box 85 Off
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- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
6
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Undergraduate Degree Qualifications
TitleofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Online Access to Qualification Details(May be used in lieu of providing certified copies of transcripts of results)
Website address or URL
Username or User ID
Authorisation Code or Password
e g w w w u cd i e v e r i f y
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course and the grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- The module titlecode which corresponds to the academic transcripts of results - A brief description of the content of each module outlining the learning outcomes
3 Aphotocopyofthequalificationparchment
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducationIfyouareapplyingfortheassessmentofyourqualificationforthe purposes of Physical Education you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed or stamped by the college or university
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
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- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
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- Text Field 15
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- Text Field 24
- Text Field 25
- Text Field 26
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- Text Field 28
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- Text Field 31
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- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
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- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
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- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
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- Check Box 49 Off
- Check Box 25 Off
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- Check Box 27 Off
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- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
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- Text Field 38
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- Text Field 49
- Text Field 50
- Text Field 51
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- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
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- Text Field 67
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- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
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- Text Field 76
- Text Field 77
- Text Field 79
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- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
7
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Teacher EducationConcurrent2 Qualification
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Subject(s) in which teaching methodologies were taken
The following mandatory documentation must be submitted for each qualification you wish to have assessed
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcript - a brief description of the content of each- the learning outcomes for each module- theschoolsandagerangescoveredintheschoolplacementelementofthisqualification- the subjects taught whilst on teaching practice - confirmationthattheteachingpracticewasdirectlysupervisedbythethird-levelinstitution
4 Languages-Ifyouareapplyingfortheassessmentofanylanguageyoumustincludeacertifiedlistofalltextsand authors studied throughout the degree programme
5 Foreign Languages (Residency Requirement) - please refer to the Teaching Council Subject Criteria (Post-Primary) available at wwwteachingcouncilie to view the residency requirement for the language that applies to you
6 PhysicalEducation-IfyouareapplyingfortheassessmentofyourqualificationforthepurposesofPhysicalEducation you must include a fully completed PE1 form which is available on wwwteachingcouncilie The PE1 form must be signed and stamped by the college or university
2 A Concurrent qualification combines the study of one or more academic subjects with teacher education studies
Postgraduate Initial Teacher EducationQualification
Concurrent Inital Teacher EducationQualification
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
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- Check Box 43 Off
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- Check Box 25 Off
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- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
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- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
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- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
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- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
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- Text Field 49
- Text Field 50
- Text Field 51
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- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
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- Text Field 63
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- Text Field 67
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- Text Field 70
- Text Field 71
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- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
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- Text Field 77
- Text Field 79
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- Text Field 85
- Text Field 89
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- Text Field 86
- Text Field 90
- Text Field 83
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- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
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- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
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- Text Field 1022
- Text Field 1011
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- Text Field 1023
- Text Field 107
- Check Box 85 Off
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- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
8
Form PPQA-01
Revised 1 January 2021
SECTION C ndash Qualifications Assessment
Other Relevant Qualifications
TitleofQualification
TypeofQualification
Awarding Authority
CollegeUniversity Attended
Year Awarded Duration of programme
Number of ECTS credits (in entire qualification) See Guidance Notes
Type of Study (Full-time Part-time Distance Learning etc)
Level of Award (Results) (eg 21 Honours Pass GPA = 342)
Please provide the following documentation for this qualification
1 Photocopyoftheofficialstatementoftranscriptsofresultsforeachyearwhichwillprovide- the titles of subjectsmodules studied in each year of the course - grades obtained - the number of ECTS credits (or equivalent) in each module (if available)
2 Aphotocopyofthequalificationparchment
3 Aphotocopyofmoduledescriptorsrelatingtoeachyearofthequalificationwhichprovides- the module titlecode which corresponds to the academic transcripts of results - a brief description of the content of each module outlining the learning outcomes
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
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- Text Field 31
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- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
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- Check Box 24 Off
- Check Box 37 Off
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- Check Box 12 Off
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- Check Box 50 Off
- Check Box 52 Off
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- Text Field 35
- Text Field 36
- Text Field 37
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- Text Field 38
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- Check Box 54 Off
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- Check Box 56 Off
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- Text Field 72
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- Check Box 59 Off
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- Text Field 93
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- Text Field 94
- Text Field 98
- Check Box 69 Off
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- Text Field 100
- Text Field 101
- Check Box 100 Off
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- Text Field 102
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- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
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- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
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- Check Box 99 Off
- Text Field 110
- Text Field 111
9
Form PPQA-01
Revised 1 January 2021
SECTION D ndash Fit and Proper Person Assessment
CHARACTER REFERENCE Note This section must be signed by a professional person in a position of academic responsibility Please refer to the Guidance Notes before completing this section
I hereby certify that in my professional capacity I have known this applicant for one academic year in the last five years and that I know of nothing in hisher character that renders himher unfit for the teaching profession
Name of Professional Person (in block capitals)
Signature of Professional Person Date
OccupationPosition of Professional Person
Address of Professional Person
Teaching Council Registration Number (if applicable)
VETTING Please refer to the Guidance Notes before completing this section
If you are applying for Vetting together with Registration please continue to complete and submit this form The Teaching Council will process your application on receipt of your vetting result from theNationalVettingBureau(NVB)andthefulfilmentofanyoverseaspoliceclearancerequirements (if applicable)
Vetting Reference Number
Date of Vetting Disclosure (if received)
OVERSEAS POLICE CLEARANCE I have providedenclose overseas police clearance documentation
Provided Enclosed NA
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
T E C 0 0 1 - 2 0 1 8 0 4 2 6 - 0 0 0 0 0
D D M M Y Y Y Y
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
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- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
10
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
Important Note Please complete Part A and Part C if previous teaching service has been completed in the Republic of Ireland Please complete all parts if teaching service has been completed outside of the Republic of Ireland
PART A TEACHING EMPLOYMENT IN A POST-PRIMARY SCHOOL To be completed by all applicants
Teacher Name
Address
Registration Number
PPS Number
School Year
School Roll No
Duration of Service Provide exact dates eg 192007 to 3062008
Formal School Name
School Address
Subject(S) Taught
Total Number of teaching hours for this subject in the periodspecified
Classroom Setting (MainstreamLearning SupportResource etc)
SubjectArea_1 SubjectArea_2 SubjectArea_3 SubjectArea_4
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
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- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
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- Text Field 70
- Text Field 71
- Text Field 68
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- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
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- Text Field 76
- Text Field 77
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- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
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- Text Field 90
- Text Field 83
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- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
11
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART B TEACHING EMPLOYMENT IN SCHOOLS OUTSIDE OF IRELAND ONLY To be completed by the School Principal (post-primary) with respect to Part A above
During the period of service did the teacher have reasonable opportunities to become acquainted with methods of teaching and discipline and did the teacher show evidence of an aptitude for teaching and the ability to manage a class
Wastheservicegivenaftertheteacherwasfullyqualifiedrecognisedbythe State Authority
Is the school subject to inspection by State Authority
Is the school in receipt of funds (or eligible to receive funds) from State Authority
Istheaboveinformationverifiedbyschoolrecords
YES NO
YES NO
YES NO
YES NO
YES NO
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
- Text Field 69
- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
12
Form PPQA-01
Revised 1 January 2021
SECTION E ndash Teaching Service
PART C CERTIFICATION ndash TO BE COMPLETED BY ALL APPLICANTS
I certify that
a the particulars given above are correct and accurate in every respect
b that the teacher named on this document provided satisfactory service for the duration recorded on this form
Name of School Principal
Signature of School Principal
Date
Registration No
School Name
Signature of Applicant
Date
P L E A S E A F F I X T H E O F F I C I A L S C H O O L CO L L E G E STA M P I N T H I S B OX
D D M M Y Y Y Y
D D M M Y Y Y Y
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
- Text Field 69
- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
13
Form PPQA-01
Revised 1 January 2021
SECTION F ndash English Language Requirement
Englishismyfirstlanguage
OR
1 Ienclosewiththisapplicationaphotocopyofaqualification(teachereducation or undergraduate) acquired and examined through the medium of English
OR
2 I enclose a photocopy of an IELTS (International English Language TestingSystem)certificateattestingknowledgeintheEnglishlanguage with a score of 70 or above
OR
3 I enclose evidence of living and practicing in a professional capacity through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
OR
4 I enclose evidence of living and undertaking a programme of learning through the medium of English in a country that has English recognisedasanofficiallanguageforthreeoutoftheprecedingfiveyears
The Teaching Council reserves the right to independently verify the scores with IELTS All components of the IELTS test must be attempted at the same sitting The test must have been undertaken no more than five years prior to the date of submission or the applicant must provide evidence of having resided and workedstudied on a full time basis in an English speaking environment since having completed the evaluation The IELTS certificate (where required) must be supplied with the registration application form registration cannot be finalised without this document
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
- Text Field 69
- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
14
Form PPQA-01
Revised 1 January 2021
SECTION G ndash Declaration
The following questions should be answered by entering a tick () in the appropriate box In any case where the response to a question is Yes full details should be given on a separate sheet and referenced to the appropriate question
I declare that
(i) the information provided by me in all sections of this application is true and accurate
(ii) I understand that further to a vetting disclosure the Teaching Council may seek submissions documentary and other evidence to enable the Council to satisfy itself that I am a fit and proper person to be admitted to the Register of Teachers
(iii) I understand that the Council may impose conditions on my registration where it deems appropriate
(iv) I understand that the Teaching Council shall refuse to register me if it is not satisfied that I am a fit and proper person to be admitted to the Register
(v) I understand that the Teaching Council may seek information from me or any other relevant person to verify any of the information submitted by me for the purpose of this registration application
(vi) I understand that it is an offence to make a false or fraudulent declaration or misrepresentation and that it could also lead to a complaint to the Councilrsquos Investigating Committee
(vii) I understand that as a registered teacher I will be responsible for upholding and promoting the standards of the profession as set out in the Codes of Conduct and Practice for Registered Teachers Relevant information would include any involvement in activities which could bring the reputation of the profession into disrepute
(viii) I have read and understood the Councils Privacy Statement as published on the Councils website
YES NO
YES NO
YES NO
YES NO
YES NO
1 Haveyoubeenconvictedofanycriminaloffence(includingmotoringoffences)intheStateorelsewhere(UndertheNationalVettingBureau(Children and Vulnerable Persons) Act 2012 certain convictions are not required to be disclosed)
2 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by a professional or regulatory body in the State or elsewhere (including this Teaching Council or equivalent body in any other jurisdiction)
3 Haveyoubeenthesubjectofanyadverseoutcomeorfindingorsanctionfollowing an inquiry or disciplinary procedure by an employer (current or previous) in the State or elsewhere (This includes situations where workplace restrictions were imposed following an inquiry or disciplinary procedure)
4 Are you currently the subject of any pending proceedings or investigation of the kind described in 1 2 or 3 above including any pending investigation being carried out by the Health Service Executive or TUSLA the Child and Family Agency
5 Is there any other relevant information that the Council should know about which may have a bearing upon your suitability to register
Signature of applicant
Date D D M M Y Y Y Y
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
- Text Field 69
- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
15
Form PPQA-01
Revised 1 January 2021
There is no additional fee for vetting Please choose one of the following payment options PLEASE DO NOT SUBMIT CASH
Option 1 DebitCredit Card
Master Card Visa (Credit or Debit)
Card Number
Expiry Date -
CVVCVN The last three digits of the security code on the reverse of the card
Cardholderrsquos name (please print name)
Cardholderrsquos signature
NOTE This page will be securely disposed of once processed
Option 2ChequePostalOrderorBankDraftmadepayabletoTheTeachingCouncil
IencloseaChequePostalOrderBankDraft
SECTION H ndash PaymentCalculation of Fees
Fee Schedule Fee Amount Submitted
Initial Teacher Education Assessment euro200 euro
Subject 1 euro100 euro
Subject 2 euro100 euro
Registration fee The registration fee is refundable if registration is not granted
euro90 euro90
Total Amount Submitted euro
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
- Text Field 4
- Text Field 12
- Text Field 5
- Text Field 13
- Text Field 6
- Text Field 14
- Text Field 7
- Text Field 15
- Text Field 8
- Text Field 16
- Text Field 17
- Text Field 18
- Text Field 19
- Text Field 20
- Text Field 21
- Text Field 22
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 27
- Text Field 28
- Text Field 29
- Text Field 31
- Text Field 32
- Text Field 30
- Check Box 1 Off
- Check Box 2 Off
- Check Box 3 Off
- Text Field 33
- Text Field 34
- Check Box 4 Off
- Check Box 6 Off
- Check Box 5 Off
- Check Box 7 Off
- Check Box 8 Off
- Check Box 9 Off
- Check Box 10 Off
- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
- Check Box 38 Off
- Check Box 39 Off
- Check Box 40 Off
- Check Box 41 Off
- Check Box 42 Off
- Check Box 43 Off
- Check Box 44 Off
- Check Box 45 Off
- Check Box 46 Off
- Check Box 47 Off
- Check Box 48 Off
- Check Box 49 Off
- Check Box 25 Off
- Check Box 26 Off
- Check Box 27 Off
- Check Box 28 Off
- Check Box 29 Off
- Check Box 30 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 33 Off
- Check Box 34 Off
- Check Box 35 Off
- Check Box 36 Off
- Check Box 12 Off
- Check Box 13 Off
- Check Box 14 Off
- Check Box 15 Off
- Check Box 16 Off
- Check Box 17 Off
- Check Box 18 Off
- Check Box 19 Off
- Check Box 20 Off
- Check Box 21 Off
- Check Box 22 Off
- Check Box 23 Off
- Check Box 50 Off
- Check Box 52 Off
- Check Box 51 Off
- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
- Text Field 41
- Text Field 42
- Text Field 43
- Text Field 44
- Text Field 45
- Text Field 38
- Text Field 39
- Text Field 46
- Text Field 47
- Text Field 48
- Text Field 49
- Text Field 50
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 54
- Check Box 54 Off
- Check Box 55 Off
- Text Field 55
- Text Field 56
- Text Field 57
- Text Field 58
- Text Field 61
- Text Field 62
- Text Field 63
- Text Field 59
- Text Field 60
- Text Field 64
- Text Field 67
- Text Field 69
- Text Field 70
- Text Field 71
- Text Field 68
- Text Field 65
- Text Field 66
- Check Box 56 Off
- Check Box 57 Off
- Check Box 58 Off
- Text Field 72
- Text Field 74
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 81
- Text Field 85
- Text Field 89
- Text Field 82
- Text Field 86
- Text Field 90
- Text Field 83
- Text Field 87
- Text Field 91
- Text Field 84
- Text Field 88
- Text Field 92
- Text Field 80
- Text Field 78
- Text Field 73
- Check Box 59 Off
- Check Box 61 Off
- Check Box 63 Off
- Check Box 65 Off
- Check Box 67 Off
- Check Box 60 Off
- Check Box 62 Off
- Check Box 64 Off
- Check Box 66 Off
- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
- Text Field 96
- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
- Check Box 70 Off
- Check Box 71 Off
- Check Box 72 Off
- Check Box 73 Off
- Check Box 74 Off
- Check Box 75 Off
- Check Box 77 Off
- Check Box 79 Off
- Check Box 81 Off
- Check Box 83 Off
- Check Box 76 Off
- Check Box 78 Off
- Check Box 80 Off
- Check Box 82 Off
- Check Box 84 Off
- Text Field 100
- Text Field 101
- Check Box 100 Off
- Check Box 103 Off
- Check Box 104 Off
- Check Box 101 Off
- Check Box 102 Off
- Text Field 102
- Text Field 103
- Text Field 104
- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
- Text Field 1016
- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
- Text Field 1025
- Text Field 1027
- Text Field 1013
- Text Field 1017
- Text Field 1021
- Text Field 1010
- Text Field 1030
- Text Field 1014
- Text Field 1018
- Text Field 1022
- Text Field 1011
- Text Field 1015
- Text Field 1019
- Text Field 1023
- Text Field 107
- Check Box 85 Off
- Check Box 86 Off
- Check Box 87 Off
- Check Box 88 Off
- Check Box 89 Off
- Check Box 90 Off
- Check Box 91 Off
- Check Box 92 Off
- Check Box 93 Off
- Check Box 94 Off
- Check Box 95 Off
- Check Box 96 Off
- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
16
Form PPQA-01
Revised 1 January 2021
SECTION I ndash Applicant Checklist
ThisapplicationformoutlinesspecificdocumentationwhichmustbeprovidedThisisrequiredtoenabletheCounciltomakeaninformeddecisionastowhetheryourqualification(s)meet(s)specificrequirements for registration
Failure to submit all documentation requested will result in your application being returned
Before submitting your application you should ensure that you have done enclosed the following
1 I have read the Guidance Notes prior to completing this application form
2 IhavefullycompletedthisapplicationformandhaveenteredNAinanyfieldthatisnotapplicable
3 Ihaveprovidedaphotocopyofidentification(birthcertificatecurrentpassport)
4 Ihaveincludedaphotocopyofmymarriagecertificatedeedpolltofacilitateanamechange(if applicable)
5 IhaveprovidedaphotocopyofstatementofQualifiedTeacherstatusandastatementfromthecompetentauthorityinthecountryinwhichItrainedconfirmingthatIamfullyrecognised as a teacher in that country and have completed any period of statutory inductionIfcompletedinanEUEEAmemberstatemystatementconfirmsthatIamrecognised under the EU Directive 200536EC
6 I have provided photocopies of the academic transcripts of results for each of my qualificationsshowingthegradesresultsattainedandfinalaward
7 I have provided a photocopy of the module descriptorscourse outline providing a description of each module studied
8 If applying on the basis of a language I have provided proof of residency in a country where that language is the vernacular (only applicable for those applying for assessment of a language)
9 IfapplyingonthebasisofalanguageIhaveprovidedacertifiedcopyofthelistoftextsandauthorsstudiedthroughoutthequalification(s)
10 IhaveprovidedCertifiedtranslationsofanydocumentsabovenotwrittenintheEnglishLanguage
11 If seeking to be assessed in respect of the curricular subject Physical Education I have completed a PE1 form which has been signed and stamped by the relevant collegeuniversity (available for download on the application forms page of wwwteachingcouncilie)
12 I have completed Vetting through the Teaching Council website or have recently submitted a Vetting application to the Teaching Council or I enclose a Vetting application now
13 IhaveincludedtheQualificationAssessmentandRegistrationfee
14 I have provided evidence that I have the necessary knowledge of English to communicate effectively(asapplicable)
15 I understand that the information provided by me on this application form will be used to contact me for registration purposes (including postal email and SMS correspondence)
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
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- Text Field 31
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- Check Box 1 Off
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- Check Box 4 Off
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- Check Box 50 Off
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- Text Field 35
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- Check Box 56 Off
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- Check Box 59 Off
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- Text Field 93
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- Text Field 94
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- Check Box 69 Off
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- Text Field 100
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- Check Box 100 Off
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- Text Field 102
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- Text Field 108
- Text Field 1028
- Text Field 1012
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- Text Field 109
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- Text Field 107
- Check Box 85 Off
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- Check Box 97 Off
- Check Box 98 Off
- Check Box 99 Off
- Text Field 110
- Text Field 111
17
Form PPQA-01
Revised 1 January 2021
Signature of applicant
Date
Please send the completed application form including all mandatory documentation to
The Teaching Council Block A
Maynooth Business Campus Maynooth Co Kildare
W23 Y7X0 Ireland
D D M M Y Y Y Y
The Council reserves the right to verify any documentation submitted in support of an application andor requestoriginaldocumentsifnotsatisfiedwiththephotocopiesprovidedTheCouncilalsoreservestheright to request additional documents should it be required to determine suitability for registration
- Text Field 1
- Text Field 9
- Text Field 2
- Text Field 10
- Text Field 3
- Text Field 11
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- Text Field 12
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- Check Box 1 Off
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- Text Field 33
- Text Field 34
- Check Box 4 Off
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- Check Box 11 Off
- Check Box 24 Off
- Check Box 37 Off
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- Check Box 12 Off
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- Check Box 50 Off
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- Check Box 53 Off
- Text Field 35
- Text Field 36
- Text Field 37
- Text Field 40
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- Text Field 38
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- Text Field 46
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- Text Field 50
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- Check Box 54 Off
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- Text Field 55
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- Check Box 56 Off
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- Text Field 72
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- Text Field 73
- Check Box 59 Off
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- Check Box 65 Off
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- Check Box 60 Off
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- Check Box 68 Off
- Text Field 93
- Text Field 95
- Text Field 99
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- Text Field 97
- Text Field 94
- Text Field 98
- Check Box 69 Off
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- Text Field 100
- Text Field 101
- Check Box 100 Off
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- Text Field 102
- Text Field 103
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- Text Field 105
- Text Field 106
- Text Field 108
- Text Field 1028
- Text Field 1012
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- Text Field 1020
- Text Field 109
- Text Field 1029
- Text Field 1024
- Text Field 1026
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- Text Field 1027
- Text Field 1013
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- Text Field 1021
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- Text Field 1030
- Text Field 1014
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- Text Field 107
- Check Box 85 Off
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- Text Field 110
- Text Field 111
