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
Please select...
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
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 Talks
Student Talks
Teacher Professional Development Workshops
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)
Teacher Professional Development Workshops
Which I CAN Programs are you interested in or would like further information on?
Teacher Professional Development Workshops
NSW Schools
For details of our program in NSW schools please refer to the NSW Student Wellbeing external program catalogue.
Further comments
How did you hear about the I CAN School program and/ or I CAN speakers?
Please select...
Amaze Autism Connect
Education Conference
I CAN Facebook Page
I CAN Newsletter
I CAN website
Navigator
Neighbouring School
Parent Support Group
Returning School
School Leaders Webinar Series
Talk by Chris Varney
Talk by I CAN staff member
VDET School Mental Health Menu
Word of mouth
Do you intend to use DE Mental Health Menu Funding to pay for the program?
Please select...
Yes
No
Unsure
Please upload your DE Mental Health Menu Request for Quote Document (optional)
Information is collected and handled in accordance with I CAN Networks Privacy Policy, available
here
.
Thank you for your expression of interest!