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Stonewall School Champions Registration Form

School name	*
Local authority school located in:	*
General school email address:

Is your school a primary or secondary school?	*
Please tick all of the options below that apply to your school:
Maintained school
Academy
Free school
Independent school
Faith school
Special school
Sixth form

*

How many pupils at your school?	*
How many teaching staff at your school?
How many non-teaching staff at your school?

Details of our main contact at your school

Title
First Name	*
Surname	*
Job Title	*
Telephone	*
Email	*
Postal address 1	*
Postal address 2	*
Postal address 3	*
Postal address 4
Postcode	*

Confirmation

Please tick below to confirm the following statement:

We, the above named school, are committed to taking active steps to tackle homophobic bullying in our school. We wish to apply to become a Stonewall School Champion.

We confirm the above statement

Payment

Please invoice us for:	*
If you wish to provide a Purchase Order Number for the invoice please do so here:


Stonewall website

Please indicate below whether you would be happy for Stonewall to promote your membership of the School Champions programme by listing the name of your school on our website.
*

Please tell us how you heard about the programme:	*
Other - please specify:	*
Please select the 'Submit' button below once you have fully completed the form. By clicking submit, your school is agreeing to pay the programme membership fee. A member of the Stonewall Education team will be in touch shortly to follow up on your application.

If you need any help filling out this form, or have any other questions, please call our education team on 020 7593 1871 or email Lauren Weller at lauren.weller@stonewall.org.uk.