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ITC APPLICATION FORM

PERSONAL INFORMATION
FIRST NAME:
NAME ON THE
CERTIFICATE:
TITLE:
EMAIL ADDRESS:
GENDER:
NATIONALITY:
CURRENT SCHOOL:
COUNTRY:
IS YOUR SCHOOL AN ECIS
MEMBER?
IS YOUR SCHOOL A CIE
CENTRE?
YEARS IN TEACHING?
SUBJECT(S) TAUGHT?
GRADE/YEAR LEVEL:
JOB TITLE:
SCHOOL MAILING
ADDRESS:
SCHOOL WEB ADDRESSS
Please include international dialing code
PHONE NUMBER:
MOBILE/CELL NUMBER

LAST NAME:

What institute are you applying for?


FIRST CHOICE
SECOND CHOICE
WHO WILL FUND YOUR
PARTICIPATION?
QUALIFICATIONS
Please give details of any degrees(s) and other professional qualifications. Begin with your most
recent qualifications.
QUALIFICATIONS
EARNED (e.g. BA,
BEd, PGCE)

FROM/YEAR

TO/YEAR

COLEGE/UNIVERSITY/
ORGANISATION

FROM/YEAR

TO/YEAR

COLEGE/UNIVERSITY/
ORGANISATION

QUALIFICATIONS
EARNED (e.g. BA,
BEd, PGCE)

FROM/YEAR

TO/YEAR

COLEGE/UNIVERSITY/
ORGANISATION

QUALIFICATION
S EARNED (e.g.
BA, BEd, PGCE)

FROM/YEAR

TO/YEAR

COLEGE/UNIVERSITY/
ORGANISATION

QUALIFICATIONS
EARNED (e.g. BA,
BEd, PGCE)

CAREER HISTORY
Please give details of your teaching career and other relevant experience. Begin with your most
recent position.
FROM/YEAR

TO/YEAR

POSITION HELD
AND MAIN AREAS
OF RESPONSIBILITY

SCHOOL/EMPLOYER
AND COUNTRY

FROM/YEAR

TO/YEAR

POSITION HELD
AND MAIN AREAS
OF RESPONSIBILITY

SCHOOL/EMPLOYER
AND COUNTRY

FROM/YEAR

TO/YEAR

POSITION HELD
AND MAIN AREAS
OF RESPONSIBILITY

SCHOOL/EMPLOYER
AND COUNTRY

FROM/YEAR

FROM/YEAR

TO/YEAR

TO/YEAR

POSITION HELD
AND MAIN AREAS
OF RESPONSIBILITY

POSITION HELD
AND MAIN AREAS
OF RESPONSIBILITY

SCHOOL/
EMPLOYER AND
COUNTRY

SCHOOL/
EMPLOYER AND
COUNTRY

In your career, which curricula did you work with? Please tick as many as applicable:

IBDIP
IBMYP
IBPYP
IGCSE
CAMBRIDGE PRE-U
IPC
A' LEVELS
ADVANCED PLACEMENT (US)
NATIONAL

Please give details of two referees including contactable email address. Referee 1 must be your
current head of school or divisional principal.

REFEREE 1
NAME
JOB TITLE
SCHOOL
SCHOOL WEB
COUNTRY
SCHOOL EMAIL
IS THIS YOUR SCHOOL
HEAD/DIVISIONAL
PRINCIPAL?
REFEREE 2
NAME
JOB TITLE
SCHOOL
SCHOOL WEB
COUNTRY
SCHOOL EMAIL
Continuing Professional Development
Please give details of the main aspects of your continuing professional development during the last
two years. How have you used your continuing professional development to improve your practice
in an international/intercultural context
Please write 400 - 500 words. IT IS RECOMMENDED THAT YOU WRITE AND SAVE THIS
TEXT IN WORDPAD OR OTHER TEXT EDITOR AND TO COPY AND PASTE HERE BEFORE
SUBMITTING IN CASE OF ANY UNFORESEEN CONNECTION ERROR.

Why do you want to participate in the ECIS International Teacher Certificate Program?
Please explain
- your rationale for wanting to participate in the ITC
- how the ITC can improve your teaching and learning in an international/intercultural context

Please write 400 - 500 words. IT IS RECOMMENDED THAT YOU WRITE AND SAVE THIS
TEXT IN WORDPAD OR OTHER TEXT EDITOR AND TO COPY AND PASTE HERE BEFORE
SUBMITTING IN CASE OF ANY UNFORESEEN CONNECTION ERROR.

Have you read and accepted the terms of the Teacher Application Agreement?
Yes
No
Do you agree for CIE to pass your portfolio of ITC work to ECIS for review?
Yes
No
How did you hear about ITC?

IB
If you are applying for the ITC with the intention of applying for the International Baccalaureate
Certificate in Teaching and Learning you will be redirected to an additional form. You will also need
to complete an additional form after the institute.
If you give any information which you know is untrue or if you withhold any relevant information, this
may lead to your application being rejected or, if you have already been accepted, to your
withdrawal from the program and/or loss of certification.
Please complete all the relevant fields in this form before submitting it.
If you have any problems, please contact helpdesk@ecis.org
Fields marked with an asterisk * are required fields.
Please email scanned copies of qualifications to itc@ecis.org

UK Data Protection Act 1998


The ECI Schools will process the information collected in this form for the purpose of assessing
teachers' applications to participate in a program for the ECIS International Teacher Certificate. This
information will only be used by ECIS and its partner institutions in the program.

PLEASE SUBMIT TO itc@ecis.org