Shine A Light Awards 2018 Application Form The Katie Rough Memorial Award Deadline for applications: 12th January 2018 @ 11.59pm (UK time) Eligibility This award is open to all settings, organisations, services and individuals in England for innovative, inspirational or excellent practice when working with children or young people affected by Selective Mutism. Katie, who had Selective Mutism, died, aged 7, in 2017 and this award is offered in her memory. All entrants must agree to the terms and conditions for the award and be eligible to apply. A copy is available at www.shinealightawards.co.uk Completing the Application Form: Entering the Shine a Light Awards can be submitted in one of the following two formats: 1. Written application of no more than 1000 words (see word allocation for each question). 2. Video application lasting no longer than 5 minutes, with a 200-word supporting statement. All applications for The Katie Rough Memorial Award must address the following questions: 1. Tell us about yourself or the person you have nominated? (max 250 words) 2. What have you/they done in the last year to be considered for this award? (max 250 words) 3. What difference have you/they made to a child/children or a young person/people with SM? (max 250 words)
Guidance The winner of this award, will be an outstanding organisation/individual who: Has helped others to understand more about Selective Mutism (SM). And/or has demonstrated excellent practice, innovation and/or creativity in supporting a child/children or young person/people with SM. And/or has demonstrated a commitment over and above their role in raising awareness about or support for those with SM. If you have any queries regarding your application, please contact our team at shinealight@pearsonclinical.co.uk. 1. About you: Please enter the details of the main person who should be contacted regarding this application. Please ensure you provide either a telephone number or an email address so that we can contact you. Name: Job Title: Organisation: Address 1: Address 2: Town: City: County: Postal Code: Telephone Number: Email Address:
2. Nomination The Katie Rough Memorial Award: Nominated Organisation or Individual: Please note: you will need to complete all fields before moving on to the next stage in the application. Name of organisation/ individual: Type of Organisation: Location: 3. Application Questions All applications for The Katie Rough Memorial Award must address the following questions: 1) Tell us about yourself or the person you have nominated? (max 250 words)
2) What have you/they done in the last year to be considered for this award? (max 250 words) 3) What difference have you/they made to a child/children or a young person/people with SM? (max 250 words)
4. Submitting your application: Supporting Evidence Please ensure that all supporting documents e.g., evidence of action plans, photographic evidence, video or testimonials. Are sent together with this application. All written applications must be sent in PDF format to shinealight@pearsonclinical.co.uk, or by post to the following address: Geri Grimes Shine a Light 2018 Pearson UK One90 High Holborn London WC1V 7BH Please note: All documents/ files sent to the Shine a Light Awards 2018 team must be labelled with the Award Category and name of the nominated person/ organisation, otherwise they will not be accepted. Please confirm that you have read and agree to the terms and conditions, detailed on our website at www.shinealightawards.co.uk [ ] Yes [ ] No Note for nominee: To be entered into the Awards, nominations must be made by completing and submitting this form. All nominations must be made with the full knowledge, consent and co-operation of the nominee. Each nominator agrees to indemnify Pearson from and against any claims or liability under the Data Protection Act 1998 arising from the supply to Pearson by that nominator of any third party personal data made without such knowledge, consent and cooperation. [ ] I understand Pearson will process your data in accordance with the Data Protection Act 1998. We will use your information to notify you of your application process or to send you information relating to the Shine a Light Awards 2018. [ ] I understand Please tick if you do not wish to receive any marketing information from Pearson.
[ ] I do not want to receive marketing information Pearson would also like to share your information with other companies within the Pearson Group. Please tick if you would like your details to be shared with other Pearson Group Companies. [ ] I would like my information shared within Pearson About the Shine a Light Awards Shine a Light Awards 2018: The national awards for developing children s communication Organised by Pearson in partnership with The Communication Trust, the Shine a Light Awards is an established, annual event in education and healthcare calendars. Launched as a flagship event in 2011, as part of 'Hello', the national year of communication campaign. The Shine a Light Awards have been successful in raising the profile and phenomenal achievement of over 100 organisations, schools and individuals across England. Over the years, the awards have been a huge success and the ceremony has welcomed celebrity hosts, who have experienced speech and language difficulties, such as Gareth Gates, Vanessa Feltz, Anne Diamond, Paul Ross and David Baddiel. Note: This information will be stored on a database by Pearson Assessment. It will only be used to correspond with you regarding the Shine a Light awards. We do not sell or exchange personal information. To find out more about the awards visit: www.shinealightawards.co.uk