Section One: Organiser Details

Name of organisation submitting request * *

Event sponsor (if applicable)

Contact name * *

Contact title *

Mr Dr Miss Mrs

Email* *

Phone * *

Section Two: Event details

Event name/title * *

Event location * *

Event date / time * ** click black triangle to show calendar

Is there flexibility around the date/time * *

Event type * *

Other Conference Seminar Webinar Workshop

Event aim / purpose * *

Event website and/or advertising (if applicable)

Section Three: Presentation details

Focus area * ** To select multiple areas hold down the control key when selecting

None English HPE HASS Judging Standards K-10 Outline Languages Policy Mathematics Science Technologies The Arts Years 11 and 12

Requested topic * *

Requested speaker (if known)

Presentation format * *

Opening address Closing address Keynote address Workshop Panel discussion Lecture

Presentation time *

Time allocated for the presentation *

Less than 30 minutes 30 minutes to 1 hour 1 hour to 1.5 hours 1.5 hours to 2 hours 2 hours to 2.5 hours

Audio visual equipment available at the venue (if required by the presenter)

• Projector
• PA system
• Computer
• Screen

Any additional details we should know, such as other speakers at the event?

Section Four: Audience details

Audience size * *

less than 10 10 - 30 31 - 50 more than 50

Audience *

• Teachers
• School leaders
• Heads of Learning Area
• University students
• Other

Honourable guests that need to be acknowledged

Media in attendance (if applicable)

• Yes
• No

Section Five: Additional information

Deadline for SCSA acceptance * * ** click black triangle to show calendar

Other relevant details

Offer of reimbursement of costs (air travel, accommodation)

• Yes
• No

Reimbursement for * ** To select multiple areas hold down the control key when selecting

-- Please Select -- N/A Parking Travel Accommodation