Get Involved! — National Ambassador Scheme

Registration form for the National Ambassador Scheme

Name

First Name

Last Name

School name*

School location*

School type (please select all that apply) *

If 'Other' is selected, please specify below

State

Grammar

Private

Academy

College

Other

Have you worked with The Black Curriculum before? *

If the answer to the above question is 'Yes' please state what service(s) The Black Curriculum delivered

How many young people do you think would sign up for the scheme? *

Please include year groups too. For example: approximately 20 young people from Year 9 and Year 10

How many hours are teachers able to spend supporting students? *

E.g. 1 hour a week after school

When would you look to start the scheme? *

October

November

December

Any additional comments or questions?

Scheme costs: