Please fill in the details below regarding your Lancashire Teaching Agency training provision.

All fields marked with an asterisk must be completed.

First name *

Surname *

Are you an Early Career Teacher - ECT? *

Email Address *

Please confirm your email address.

XMS Payroll Number *

Please indicate the Key Stage(s) you mainly teach

Key Stage One

Key Stage Two

Key Stage Three

Key Stage Four

* indicates that you must supply an answer

PO Box 78, County Hall, Fishergate, Preston, Lancashire, PR1 8XJ