Please use this form if to tell us about any learning champions activity that you are involved in.

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1. Contact Name*

2. Email Address*

3. Name of your community learning champion scheme

4. Is your learning champions or community learning champions scheme....*
New and about to ‘go live’?
Currently active?
Recently closed?

5. When was it set up?*

6. What target groups do you work with?*

7. How many community learning champions has your scheme supported?

8. How many learners have been engaged in learning as a result of the work of your community learning champions?

9. What support would be useful to you?

10. Would you like to receive updates about the Community Learning Champions Support Programme, including information about funding, training and support opportunities and how you can get involved in the work of the project?*
Yes
No

11. Please use this space for any other information you would like to tell us about your scheme.