Student Application Form

Personal Details

TitleMrMissMrsMsDr

Surname

Forename(s)

Date of Birth

Teachers ref number

Home Address

Postcode

Home telephone

Mobile number

Email address

Personal History

College/University at which trained

Have you previously been a member of the Ulster Teachers' Union?StudentFullNo

Please give previous name if relevant

Date of completion of College/university course

Present Employment Status

Teachers in Permanent Employment

School

School Roll Number (if known)

School Postcode

Position

Please keep us informed if you move to another school.

DISCLAIMER "Any omission or inaccuracy in the particulars furnished on this form may, at the discretion of the Executive of the Union invalidate an application for membership and any grant of membership made in reliance thereon."