FOR NLT STAFF USE

Select which hub/team this form is for

Which KPI metrics does this form relate to? Please tick as many as suitable

ReachEngagedCompetition Entry

Is this just an expression of interest form or do you want to collect number of attendees?

Expression of interestNumber of attendees

Please select whether this activity relates to Connecting Stories and/or Literacy Champions (leave this as blank if neither apply)

Connecting Stories

Literacy Champions

Game Changers and Words that Count are targeted at students aged 11-14 who have been excluded or are at risk of exclusion (including those that self-exclude).

Please indicate that you are aware of the target audience.I consent to being contacted about the Game Changers programme when it launches

School Details

Please complete this with the details of the person who will be delivering the Empower programme. All programme information will be sent to the details provided below.

First Name

Last Name

Are you completing this on behalf of a school or organisation?

SchoolOrganisation

Job Title (including subject if teacher)

Please enter your school or Club Community Organisation email address (not your personal email)

School or Organisation Name

From the following options, which best describes your setting?

Alternative Provision (including PRUs, SEMH, Hospital School)Mainstream School with an Internal Exclusion UnitMainstream School without an Internal Exclusion Unit

I am interested in the following programme(s) (tick as many as are applicable):

Game ChangersWords that CountFuture projects aimed at this audience

Is this address a household or organisation?

HouseholdOrganisation