L E A P (NSW)
Leading Educators Around the Planet Pty Ltd
ACN 134043851 ABN 13 134043851
International Peer Shadowing Leadership Program for Experienced Educational
Leaders
LEAP NSW – International Membership Form 2017
Application instructions
1. Download this form.
2. Complete this Membership Matching Profile Form (pp1-6) and return electronically
as an attached WORD doc (this Matching Profile will be shared with your
international partner).
3. Complete the Personal Obligations (p. 7) and return this page via post to: PO Box 71,
Hill Top, NSW, 2575.
4. Payment of the due fee (as outlined on page 2 & 7) to be submitted on application. If
the match does not proceed the membership fee will be fully refunded.
5. Retain a full copy of your application.
Matching Profile/Membership Application Form Contents:
Section 1: Program Profile (Page 2)
Section 2: School/Work Profile (Page 3)
Section 3: Personal Profile (Page 4)
Section 4: Action Learning Project Profile (Page 5)
Section 5: Program Expectations and Dates (Page 6)
Section 6: Personal Obligations (Page 7)
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Section 7: Program Summary (Page 8)
SECTION 1: PROGRAM PROFILE
1. Please indicate your name: ________________________________
2. Please indicate your current position:
o
o
o
o
Principal
Experienced Deputy Principal
Director
Non-School Based position:________________________________
3. Please list your location preferences (one or more) with #1 being your highest priority:
3.1 Participation in a reciprocal program with all locations (listed below) has a membership
fee of $550 (which does not include the cost of voluntary overseas professional
development activities)
o
o
o
o
o
o
Canada:
o
o
o
Alberta
New Brunswick
British Columbia
o
o
o
Essex
South Gloucestershire
Nottinghamshire
o
Alabama
England:
Scotland
Finland
Ireland
USA
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SECTION 2: SCHOOL/WORK PROFILE
School/Work Place: _____________________________________________________
School/Work Place address: ______________________________________________
________________________________________________
Work Contact details:
o
o
o
MobilePhoneEmail-
School /Work Place profile:
Please include specific school information (e.g. classification; enrolment numbers; special programs;
additional funding sources; geographic location; special education units; ATSI enrolments; student
and staff profiles); or specific Work Place description if non school-based environment.
Professional history:
(Please include any relevant research, awards, professional associations, years in the principalship
and/or current position, PPA/SPC involvement, qualifications & other relevant experiences etc.)
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SECTION 3: PERSONAL PROFILE
Name: ___________________________________________
Please insert
portrait
photo here.
Age: ________
Gender: _____________
Personal phone contact: _______________________________
Home address: _______________________________________
_______________________________________
1. Family Profile:
2. Accommodation Profile:
(Please include: any pets you may have; smoking or non-smoking; bedrooms available,
bathrooms available etc.)
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3. Accompanying travelers:
o
Is your spouse/partner planning to be travelling with you?
o
o
o
The conditions for a spouse/partner travelling are:
This arrangement must be suitable to and agreed to your host
The spouse/partner is not a part of the LEAP educational program and must be self-reliant
during the period of the educational program
The spouse/partner is welcomed to participate in all aspects of the LEAP social program
(some of which will have a cost associated)
o
o
Allergies:
o
Do you have any allergies?
o
If "Yes" please give details:
Yes/No
Yes/No
5. Personal hobbies and interests
SECTION 4: ACTION LEARNING PROJECT PROFILE
As part of this program you are encouraged and supported to undertake a brief action-learning
project by investigating an area of personal professional interest in another educational jurisdiction
(i.e. Canada, Finland, Ireland, USA or United Kingdom). At the Sharing Conference in November, each
participant is expected to share a one-page action-learning brief.
Proposed area of study:
o
Focus area (e.g. curriculum; professional learning; student outcomes)
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o
Research question (e.g. How is the literacy program delivered in Y3-Y6? What is the selection
process for principals and deputy principals? How is professional learning organized across
the jurisdiction? What local autonomy and authority does the school principal have?)
o
Brief description/outline (e.g. why is this the chosen area; how do you plan to gather your
data; what support might you require from your international colleague):
SECTION 5: PROGRAM EXPECTATIONS

Reciprocal membership fee of the 2017 LEAP NSW Program is $550 (for all locations listed)

Participants in LEAP NSW 2017, have access to all phases of the program. At the appropriate
time it will be necessary to register to attend each event. Please read each phase carefully.
Preparation Phase:





Lodgment of application and payment of membership fee
Matching by NSW LEAP coordinators with an international colleague
Communication (e.g. email) with your international colleague
Attendance at an Introductory Pre-orientation/Social Function (Saturday 1st April) and/or
Attendance at the Program Orientation Seminar (Saturday 3rd June)
Phase 1:

In addition to billeting and hosting my international colleague (23rd July until 2rd August) I
undertake to organize and facilitate an appropriate shadowing, professional learning and
schools visitation experience for my international colleague from 23rd July until 2rd August

Membership of LEAP 2017 will also provide access to the following events (with my
international colleague). I realize that my membership will have paid for my attendance but
that I will need to register for these events:



The Welcome Luncheon Seminar Venue TBA (Sunday 23rd July)
The Schools Visitation Program (which I organize locally)
The International Leadership Conference @ Masonic Conference Centre, 66 Goulburn St,
Sydney: Program TBA (Wednesday 2rd August)
The Farewell Dinner Seminar @ Venue TBA (Wednesday 2rd August)

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Phase 2:





Billeted and hosted by my international colleague at their home and school from Sunday 24th
September until Wednesday 4th October
Attendance (with my international colleague) at my host’s Welcome function (Sunday 24th
September)
Participation in appropriate shadowing and educational experiences facilitated by my
international colleague
Attendance at optional professional development activities offered by my host/jurisdiction.
These may include an attendance fee (TBA)
Attendance (with my international colleague) at the Farewell Dinner function (Wednesday
4th October)
Phase 3:

Attendance at the LEAP NSW Sharing Conference to present my action learning report and
engage in program evaluation; date and venue TBA
Split Program Option: when membership is taken over two years (i.e. host one year and travel a
different year) the membership fee covers one round of the NSW-based LEAP PL and social events:
(one Welcome Luncheon; one Schools Visitation Program; one LEAP conference; one Farewell
Dinner; and one Sharing conference).
SECTION 6: PERSONAL OBLIGATION
I hereby apply for Reciprocal Membership of LEAP NSW for 2017 according to the conditions of
the program outlined above.
 I enclose my cheque $550 (for other locations) made payable to "Leading Educators
Around the Planet Pty Ltd" (LEAP, PO Box 71, Hill Top. NSW, 2575 ; or
 I have submitted payment by Direct Deposit for $550 to: BSB: 812-170; Account name:
LEAP Pty Ltd; Account Number: 164673
I acknowledge that all costs associated with my travel, travel insurance, additional
accommodation (excluding billeting), personal and incidental costs etc are not covered by the
membership, and that they are my own personal responsibility (as per LEAP NSW Membership
Obligations 2017 Form).
Name
Signed
Date
LEAP NSW:
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Directors: Sue Lazenby and Warren Marks
Phone: 02 4889 8696
Mobiles: 0412 049 637 (Warren); 0412 960 108 (Suzanne)
E-mail: [email protected] or [email protected]
Postal address:
LEAP,
P.O. Box 71,
Hill Top,
NSW 2575
L E A P (NSW)
Leading Educators Around the Planet Pty Ltd
ACN 134043851
SECTION 7: PROGRAM SUMMARY
In addition to a professionally matched international educational leadership partner (for the
duration of the program) LEAP NSW Reciprocal Membership fee for 2017 ($550) provides funded
and registered attendance at:

LEAP NSW Welcome Luncheon Seminar - Sunday 23rd July 2017

LEAP NSW Schools Visitation Program – TBA

LEAP NSW International Leadership Conference – Wednesday 2nd August, 2017

LEAP NSW Farewell Dinner Seminar – Wednesday 2nd August, 2017

LEAP NSW Reporting/Sharing Workshop – TBA
Participation in the LEAP Program provides access to tertiary accreditation at Macquarie University
(for further information contact Sue Lazenby or Warren Marks).
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NB: This membership fee is solely related to the activities listed above. All travel costs; travel
insurance and health costs; billeting expenses; additional accommodation costs; hospitality costs; or
any personal and incidental costs associated with being involved in LEAP NSW 2017 are the personal
responsibility of the LEAP NSW participant. Please retain this page (Section 7) for your own records
(and potentially for taxation purposes).
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