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I CAN Network

I CAN School® Program/Speaker Services - Expression of Interest

Thank you for your interest in I CAN Network. Please complete the form below so that we may pass on your information to our Business Development Team who will contact you to provide further information.

Please note that this form is only to be completed by school staff. If you are a parent/guardian and are interested in I CAN Network programs please contact your school's Disability Coordinator and encourage them to complete this form.

School Details

School Name (Please search and select your school OR type the name in)

School Street

School Suburb

School Postcode

School State

ABN (11 digits, no spaces)

Your Details

School Contact First Name

School Contact Last Name

School Contact Position

School Phone (no spaces, commencing with zero)

Please include 2 digit area code for landline numbers

School Contact Email

Which I CAN Programs are you interested in or would like further information on?

I CAN Schools Mentoring Program (Secondary Schools)I CAN Imagination Club (Primary schools)Parent and Family TalksStudent TalksTeacher Professional Development Workshops

Which I CAN Programs are you interested in or would like further information on?

Teacher Professional Development Workshops

Further comments

How did you hear about the I CAN School program and/ or I CAN speakers?

Do you intend to use DE Mental Health Menu Funding to pay for the program?

Please upload your DE Mental Health Menu Request for Quote Document (optional)

Information is collected and handled in accordance with I CAN Network's Privacy Policy, available here.

I confirm that I have read and understood I CAN Network's Privacy Policy.

Yes

Thank you for your expression of interest!