Education and Community Event Request Form

Education and Community Event Request Form

All requests will be considered however our capacity is dependent on the availability of our staff. Four weeks notice is helpful for us to organise ourselves and ensure that we have staff freed up to participate. Please fill in the form below, press Submit Form and get in touch on 03 4010 7100 if you have any questions.
Organisation/ School*
Contact*

PrefixFirst NameLast Name
Address/ Session Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Suggestions or topics you would like to be included in the workshop?*
Audience age group*
Number of participants per session*
Number of sessions requested*
Proposed session dates and time*
Special needs Y/N include details i.e behavioural issues, literacy etc. *
Resources available

LaptopProjectorProjector ScreenSpeakers/ MicrophoneInternetOther
Other information/ comments
I understand headspace may not have capacity to meet my request if I am providing LESS THAN 4 weeks notice*

Yes
Should be Empty: