School Name _______________________________________________
Contact Person ______________________________________________
Contact Phone _______________________________________________
Date Request Faxed / Emailed
____________________________________________
Workshop Title or Description
________________________________________________________________
Learning Outcome Required
_________________________________________________________________
Workshop Date or Dates _____________________________________________
Number of hours for each and TOTAL hours required
__________________________________________________________
Number of students in group or each group (where applicable)
_____________________________________________________________________
What is the gender of the group/s
All Male ___________
All Female __________
Mixed Gender _________
Which Teacher or School Staff Member be present during the workshop / presentation?
Have parental consent requirements been met for this workshop or presentation?
__________________________________________________________________________
Any other relevant information you wish to provide?
___________________________________________________________________________
Thankyou for completing the request form. Please fax or email to:
OR Fax to
(07) 4638 5360