Presentation or workshop request form

Community engagement request form

Please note we require at least 2 weeks notice before your ideal date. Completing this enquiry form does not confirm your event. You will hear back about your request within 7 working days.
Contact person*

First NameLast Name
E-mail*
Mobile Number

Phone Number
Phone Number*

Area codePhone Number
Organisation/school name *
Engagement type*
Ideal date of engagement *

DayMonthYear
Date
Ideal time of engagement

:HourMinutesAM/PM Option
Address*

Street Address

Street Address Line 2

SuburbState

Post code
Please tell us a bit about your event? What are you hoping to get out of having headspace Hawthorn attend? *
Would you like headspace Hawthorn to help promote your event/activity?

YesNo
Number of people expected to attend*
Who will be present at your event?*

Young people (aged 12-25)Children (aged 0-11)ParentsCommunity membersStaff (includes teachers)Coaches
Will there be any young people with additional learning or access needs? e.g. disability or language barrier*
Is there free parking available on site? If so, where? *
Presentations & workshops

The following questions relate to presentations and workshops. Please see the 'Presentations by headspace Hawthorn' flyer for more info on presentations. Keep scrolling for questions about info stalls.
Presentation topics (30 mins)

Keeping a healthy headspaceHow to ask: RUOK?Managing stressTackling body image & self esteemUnderstand gamingAlcohol and other drug safetyGreif and lossBullyingOther
What tech equipment is available?

Projector with working soundProjector without soundClicker for projectorLaptop (for USB port)Microphone (for large audiences)Other
What setting is the presentation/workshop taking place?

ClassroomAuditorim/lecture theatreHall/GymClubroomsOther
Additional information
Should be Empty:

Community engagement request form

Presentations & workshops