Expression of interest for STEM kit or virtual program with GTAC

Name
First Last
Email address*
School*
If other, please enter your school name here*
Select STEM kit or virtual program*
Name of person to deliver to*
Address for delivery*
Street Address Address Line 2 Suburb/Town Post code
Preferred term for the Scanning Electron Microscope to be at your school*
Preferred Date for the Delivery of the Outbreak Kit to your school*
DD slash MM slash YYYY

Approximate kit mailout dates: Term 3: 23rd July – 10th September
Preferred Date for the Delivery of the Transformation Kit to your school*
DD slash MM slash YYYY

Approximate kit mailout dates: Term 1: 17th February – 19th March
Phone number to contact you on*
Year level of students*
- Year 12
- Year 11
- Year 10
- Year 9
- Year 8
- Year 7
- Year 6
- Year 5
Number of Year 12 students*
Number of Year 11 students*
Number of Year 10 students*
Number of Year 9 students*
Number of Year 8 students*
Number of Year 7 students*
Number of Year 6 students*
Number of Year 5 students*