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Copyright
SpeakerRequestFormUnstyled
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
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