Form 1 (Formally known as Appendix F) - Patron’s Declaration
All parts of this declaration must be completed in full. (Incomplete declarations will be
returned)
Part A. [Please use block capitals]
County: ___________________________________ Roll No: __________________
Name of School: ___________________________________ School Phone No:___________________
Name of Patron:____________________________________ Patron’s Phone No:__________________
Part B. [Please use block capitals]
I confirm that I have appointed:
Title: ______ Forename________________________Surname____________________________
as Chairperson of the board of management of the above school with effect from _____/______/______
Was this person the chairperson of the outgoing Board? Yes No
Chairperson’s personal address*: _______________________________________________
______________________________________________
_______________ Eircode:
Chairperson’s personal phone No*: ________________________________________________
* This information is requested for use by Department officials only and will not be provided to third parties.
Part C.
I confirm that the election of the parent nominees to the board of management was conducted in accordance with
Appendix B of the Governance Manual for Primary Schools 2019 2023 using (please tick relevant box):
Option 1 of Appendix B Option 2 of Appendix B
Part D. [Please use block capitals]
Has this Board been appointed under a shared governance arrangement in accordance with section 3.3 of the
Governance Manual for Primary Schools 2019 2023? Yes No
If yes, please provide details of the other school involved in the shared governance arrangement;
County: ___________________________________ Roll No: __________________________
Name of School:_______________________________________________________________
Note: Please attach the completed Form 1 (formally known as Appendix F) for the other school to this
form.
Part E.
I confirm that all Board members have been appointed and the board of management has been established
in accordance with the requirements set out in the Governance Manual for Primary Schools 2019 2023 and
the Education Act, 1998.
Signed: ____________________________________ (Patron’s signature) Date: _____ ______
NOTE: Where there is a change of Chairperson during the Board’s term of office, the patron shall submit an updated Form 1
(Formally known as Appendix F) declaration to School Governance Section as soon as the appointment has been made. This form
can be downloaded from the Department’s website. It should be completed in full and returned to School Governance Section,
Department of Education & Skills, Cornamaddy, Athlone, Co. Westmeath. Eircode: N37X659.
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