FOR NLT STAFF USE
Select which hub/team this form is for
Please select...
Birmingham Hub
Black Country Hub
Blackpool Hub
Bradford Hub
Communities Team
Connecting Stories Team
Criminal Justice Team
Doncaster Hub
Early Years Team
Fundraising Team
Hastings Hub
Home Learning Environment Team
Love Our Libraries Team
Manchester Hub
Middlesbrough Hub
North Yorkshire Coast Hub
Nottingham Hub
Peterborough Hub
Read NE Team
Sport and Literacy Team
Stoke Hub
Suffolk Hub - Haverhill
Suffolk Hub - Lowestoft
Suffolk Hub - Stowmarket
Swindon Hub
Words for Work Team
Young Readers Team
Young Writers Team
Which KPI metrics does this form relate to? Please tick as many as suitable
Reach
Engaged
Competition Entry
Is this just an expression of interest form or do you want to collect number of attendees?
Expression of interest
Number 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
In order to take part in Represent, you must meet our eligibility criteria. Please confirm that you are: applying from a non-fee paying school in England, willing to participate in the online training session, willing to take part in the evaluation process.
I confirm that my school is based in England and does not charge fees to its students.
I will undertake the required training (2 x 60 minute online sessions - self paced) and take part in the evaluation.
This programme is targeted at students aged 11-14 who have been excluded or are at risk of exclusion. Please indicate that you are aware of the target audience.
School Details
Please complete this with the details of the person who will be delivering the Represent 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?
School
Organisation
Job Title (including subject if teacher)
Please enter your school or Club Community Organisation email address (not your personal email)
Address
School lookup
P
lease look up your school here, using the
name
or
postcode
.
If your school is not listed,
please leave this field empty
, and manually enter in the
School or Organisation Name
box below - ensure that your address is entered correctly otherwise your resources may be lost).
School or Organisation Name
Street Address Line 1
Street Address Line 2
City
Postcode
County
From the following options, which best describes your setting?
Alternative Provision (including PRUs, SEMH, Hospital School)
Mainstream School with an Internal Exclusion Unit
Mainstream School without an Internal Exclusion Unit
Participant age group information
Which phase of school will the pupils belong to?
Please select...
Early Years
Primary
Secondary
Post-16
Which year group are the pupils from?
Please select...
Pre-Reception
Reception
Year 1 (5 - 6 years old)
Year 2 (6 - 7 years old)
Year 3 (7 - 8 years old)
Year 4 (8 - 9 years old)
Year 5 (9 - 10 years old)
Year 6 (10 - 11 years old)
Year 7 (11 - 12 years old)
Year 8 (12 - 13 years old)
Year 9 (13 - 14 years old)
Year 10 (14 - 15 years old)
Year 11 (15 - 16 years old)
Year 12 (16 - 17 years old)
Year 13 (17 - 18 years old)
We can supply you with resources for a maximum of 10 students per term overall. How many students do you plan to run
Represent
with for the above year group? (This can be a rough estimate)
Have you taken part in any of the following programmes?
Game Changers
Represent
Skills Academy
Empower
None
Taking part in the training and evaluation is a requirement for taking part in the Represent
programme. You will be contacted in March to confirm if you will receive the programme. If you have any questions, please email sport@literacytrust.org.uk.
I understand
Is this address a household or organisation?
Household
Organisation