Professional learning request form

YOUR CONTACT DETAILS

Contact Name*

First Last

Organisation*

Email*

Enter Email Confirm Email

Phone (include area code)*

Address*

Street Address Suburb State Postcode Country

Website

ABOUT YOUR GROUP

Number of participants*

Please list the structure of your group*

All participants are from the same school or service
Participants are from different schools or services (i.e. several schools coming together for shared PL)
Other (please describe below)

About your group/participants

Session focus*

Please give a brief description of your intentions for this professional learning session/event:

AREA OF INTEREST

Preferred topic*

An introduction to Reggio Emilia
The Hundred Languages
Documentation
The role of the environment
The image of the child
Working alongside children through projects
Children's rights
Teachers as researchers
Other (please describe below)

Other area(s) of interest

Preferred DATE and TIME

Please list 3 possible dates and times below, in order of preference. We will endeavour to accommodate your request, however, all bookings are subject to the availability of the facilitator.

DATE (1st preference)*

DATE (2nd preference)*

DATE (3rd preference)*

Preferred DURATION*

1hr
2hr
3hr
Other (please indicate below)

Your preferred duration

Preferred START TIME*

Please indicate your preferred start time(s) for your session. To assist with finding a facilitator, please select ANY times that you are available. We will discuss your preferred date and time prior to confirming your booking.

Do you have any comments about your preferred date or time?

PRESENTER / FACILITATOR

We will endeavour to assist you with your preferred choice but please note this will depend on availability.

Your preferred PRESENTER / FACILITATOR

Please indicate if you have a preferred presenter for this workshop/seminar.

VENUE and CATERING

Which VENUE will you use for your session/workshop?*

Your school/centre (listed above)
The REAIE Documentation Centre (in Hawthorn, VIC)
Other (please indicate below)

NAME of your preferred venue

What is the name of your preferred venue?

Venue COST

Does this venue have a hire fee or other associated costs?

CATERING

Do you require REAIE to organise catering?

Yes
No
Not sure

Preferred caterer

Do you (or your venue) have a specific caterer you prefer or are required to use?

Yes
No
Not sure

Name of the preferred caterer

Please list the business name of the catering service and any available contact details (phone, email and/or website).

REAIE MEMBERSHIP

Are you a current REAIE Member?*

Yes
No

Please indicate your current membership level:

Organisational A
Organisational B
Organisational C
Individual Full
Individual Concession
Challenge (journal subscription)

Professional Learning Request Form