EXPRESSION OF INTEREST FOR GOVERNING BODY

EXPRESSION OF INTEREST FORGOVERNING BODY

Please complete this form if you wish to register your interest to become a member of the Governing Bodyat The Langley Academy PrimaryPersonal ManagerLangley Road, Langley, Slough, Berkshire SL3 7EFAdmission Dept : Tel: 01753 214440 Fax:01753 596323Email: tlaprimary@langleyacademy.org

NAME

Forename:*

Middle Name:

Surname:*

Date of Birth:*

Date

Gender:*

Email address:

HOME ADDRESS

Addressee"s name:

Building and street name:*

Locality name:

POSTCODE:*

SUPPORTING STATEMENT

Do you have any children attending The Langley Academy at present: (if more than one sibling attends please give name and year group of youngest)

Name:

YEARGROUP:

To your knowledge are you related to any borough Councillor and/or Governor of The Langley Academy?

This is NOT an application form. By completing this form we will keep you informed of events and developments at The Langley Academy Primary. I also understand that should false information be given in the above details, any subsequent offer will be withdrawn.

Signature(s) of Parent(s)/Carer(s):*

Date:*

Date

PERSONAL INFORMATION SUPPLIED WILL BE HELD AT THE LANGLEY ACADEMY PRIMARY AND IS SUBJECT TO THE DATA PROTECTION ACT 1998. DATA MAY BE EXCHANGED WITH OTHER LOCAL AUTHORITIES IF NECESSSARY.

FOR ACADEMY USE ONLY:

Date Application Received:

Date